ACTE Executive Forum

Registration Form

All fields are required unless marked with a "*". Name, Title and Company will appear on badge as submitted.

Name

Title

Company/Affiliation

Address

Address*

City

State/Province*

Zip/Postal Code

Country

Telephone

Facsimile*

E-Mail

Registration Fee:

ACTE Member R 210 Euro (incl. VAT)
Non-Member R 410 (incl. VAT)
Non-Member Joining R 650 (incl. VAT)

Payment:

Cheque
American Express
Diners Club
Euro/MasterCard
Visa

Cardholder Name

Card Number

Expiration Date

(Note: If you require a copy of this registration please
print using your browser's print feature before submitting this form.)

You may submit this form online, fax: +32-2-743-1550 or mail: ACTE EMEA, Avenue des Gaulois 7, B-1040 Brussels, Belgium.
You may call +32-2-743-1540 for questions or more information.

(REFUNDS ONLY GIVEN ONE WEEK PRIOR TO FORUM.)

2001 EMEA Executive Forum Sponsors