Medical Plastics 2008 |
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| Contact Information:
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Registration Form |
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| Registration details: (Fields marked with * is required) |
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Prefix |
(Mr, Mrs, Ms, Dr or Prof) |
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Name (Firstname + Surname) |
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Company |
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Company description |
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Address |
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Postcode |
(NL-1234 AB, SE-123 45, DE-12345 etc.) |
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Town |
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Country |
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| Invoice details if different from above: |
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Company |
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Address |
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Postcode |
(NL-1234 AB, SE-123 45, DE-12345 etc.) |
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Town |
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Country |
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Phone (Switchboard) |
(+46.123456789) |
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Phone (Direct No.) |
(+46.123456789) |
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Telefax |
(+46.123456789) |
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Mobile |
(+46.123456789) |
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| As the below e-mail account will be used to mail you a confirmation we kindly ask you to type only one (1) active e-mail account. |
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E-mail |
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| If your company resides inside the European Union you need to inform us of your company's VAT-no. |
| Without the VAT-no. we will have to charge you with the Danish VAT (25%). |
| Companies outside the European Union do not need to fill in the field 'VAT-no'. |
| Companies in Denmark do not need to fill in the field 'VAT-no', as we will charge them with the Danish VAT (25%). |
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VAT-no |
(DE-123 456 789, NL-123 456 789 B01) |
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| If you or your company are member of one of the sponsoring organisations, please fill in the name of the organisation. |
| The membership discount is only available if the below field are filled in. |
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Sponsor Organisations |
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Conference details: |
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Purchase Order No. |
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Seminar |
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6 October 2008 - DKK 3.300,00/€ 465,00 |
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Seminar/Conference |
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7 October 2008 - DKK 3.300,00/€ 465,00 |
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Conference |
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8 October 2008 - DKK 3.300,00/€ 465,00 |
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Discount for 2 and 3 days: 10% |
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Dinner |
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Monday 6 October 2008 - DKK 550,00/€ 78,00 |
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Dinner |
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Tuesday 7 October 2008 - DKK 550,00/€ 78,00 |
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| Hotel Accommodation: (DKK 925,00/€ 130,00 per night per person in single room incl. breakfast) |
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Arrival date: |
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Departure date: |
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Double room:
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| The name of the hotel will be informed on the invoice. Hotel and travel information on www.hexagon.dk |
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| Comments: |
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Please check that only the events you want to participate in are checked |
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