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 €150 Euro Non-Member €220 Euro Non-Member Joining €410 Euro Complimentary $0 USD ( If registering as a comp, please include "code")
Payment:
	Check American Express Diners Club MasterCard Visa
Cardholder Name
Card Number
Expiration Date
(Note: To pay by check, please do not submit this form on-line.Instead use your browser's print feature to print the completed form, make written note that a check has been mailed, and fax it to 32.2.743.15.50. You should also print this form if you require a receipt of registration.) You may submit this form online by Fax: 32.2.743.15.50 or Mail: ACTE EMEA, Avenue des Gaulois, 7 - B-1040 Brussels. You may call 32.2.743.15.89 for questions or more information. (Full refund less a handling fee of Euro 50 per registrant will be granted to request received in writing before or on the 11 March 2002. No refunds will be granted for requests after that date. Telephone cancellations will not be accepted.)

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