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 120 Euro
Non-Member 180 Euro
Non-Member Joining 380 Euro

Payment:

Cheque
American Express
Diners Club
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.

Cancellation Policy for London Forum
Full refund less a handling fee of Euro 40 per registrant will be granted to requests received in
writing before or on 29 November 2001. No refunds will be granted for requests after that date.
Telephone cancellations will not be accepted.

2001 EMEA Executive Forum Sponsors