Zoeken

Registration form NLC 2012

Personal information:

Surname
First name
Title
Organisation
Street, number
Zip-code
Place
Country of residence
Gender  Female      Male
Telephone
e-mail

Details for Name Badge & Conference Participant List - if different from above

Name Badge (name + organisation)
Participant List (name + organisation)
Email address

Type of registration

Full conference Residential Fee (€ 945)
Student Residential Fee (€ 825)
Non Residential Fee (€ 710)
Student Non Residential Fee (€ 580)
Daily Delegate Monday (€ 200)
Tuesday (€ 375)
Wednesday (€ 200)

Payment

The registration fee has to be paid to:
ING Bank
Schimmelt 36
5611 ZX Eindhoven
Bankaccount: 65 30 21 399 of Open Universiteit Nederland
IBAN: NL53INGB0653021399
BIC: INGBNL2A
Please mention your name and NLC 2012, kosten-drager 71550706

Extra nights 1 Night Single (€ 90 + City Tax)
2 Nights or more Single (€ 85 + City Tax)
1 Night Twin / Double (€ 105 + City Tax)
2 Nights or more Twin / Double(€ 100 + City Tax)
Partner Costs Bed & Breakfast (€ 15 + City Tax)
The date of the extra nights
The costs of the extra night(s) and partner costs has to be paid to the hotel.
Dinner for partner
€ 40,00 Partner attending dinner on April 2nd, 2012 in N-H Hotel Maastricht
€ 55,00 Partner attending dinner on April 3rd, 2012 in Kasteel Vaeshartelt, Maastricht
The costs of the dinner have to be paid to the Open Universiteit Nederland
Special instructions (for example: diet wishes)