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VOLUNTEER PROGRAM

Find out more about ACTE Volunteer Opportunities

AWARDS PROGRAM

Advancing the Industry Award View 2006 Award Winners

INTERACTIVE FORUMS

 

Registration Form

Brussels, Belgium

28 September 2006

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

First Name

 

Last Name

 

Title

 

Company/Affiliation

 

Address

 

Address*

 

City

 

State/Province*

 

Zip/Postal Code

 

Country

 

Telephone

 

Facsimile*

 

E-Mail

 

Membership Number*

 



Registration Fee:

   
 

ACTE Corporate Member(Enter Priority Code Below)
ACTE Non-Corporate Member(Enter Priority Code Below)
ACTE Supplier Member 175€
Supplier Non-Member Joining and Attending 345€
Non-Member Corporate Joining Both Associations 400€

Enter Priority Code Here:

 

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 1-262-763-7037. You should also print this form if you require a receipt of registration).



You may submit this form online by Fax: 1-262-763-7037 or Mail: ACTE Executive Forums, 111 S. Pine Street, Burlington, WI 53105. You may call 1-262-763-1902 or 1-800-375-ACTE for questions or more information.

(REFUNDS ONLY GIVEN ONE WEEK PRIOR TO FORUM.)