Leiden Joint Insolvency Conference registration

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LEIDEN JOINT INSOLVENCY CONFERENCE 5 - 6 JUNE 2008

Registration Form

Please note that this form is for Registration only. Accommodation should be reserved directly with the hotel of your choice (details listed in the registration brochure)

YOUR DETAILS

Title

First name

Surname

Firm / Company / University

Address

Tel

Fax

please include country codes

Reception and Dinner

I wish to attend the reception & dinner on Thursday 5 June 2008

REGISTRATION FEES:

INSOL Europe	Total € Euros –early booking fee	Please enter the fee € applicable to your booking in this column
INSOL Europe/INSOLAD member	€590
NON Member	€695
Optional drinks reception & dinner 5 June	€70
	TOTAL DUE €
	Payment amounts should be inserted to 2 decimal places e.g. €590.00


METHOD OF PAYMENT: (please check button and complete relevant section)
	A cheque in the sum of € and payable to INSOL Europe will be sent to: PO Box 7149, Clifton, Nottingham NG11 6WD, UK
	I am arranging for a bank transfer to INSOL Europe Euro Account No.10014265, Royal Bank of Scotland, Sort Code: 16 10 85, IBAN No. GB44RBOS16108510014265, BIC/Swift Code: RBOSGB2L
		Please debit my Visa/Mastercard/Amex card with the sterling equivalent of	€

		My card number is

		Expiry date

		Security Code
			(last 3 or 4 digits on reverse of card)

		Name of cardholder shown on card

		Card billing address (if different from above)




Please note that confirmation of your booking will not be issued until receipt of payment. Refunds will not be given for any cancellations received after 29 May 2008.

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