Registration form
, you can choose to pay directly with credit card after filling in this form.
Your payment will be handled by a
secure site
provided by Ogone Payment Service Provider, you'll be redirected to this page after filling in this form, where you can fill in your credit card information. You can pay with
VISA, MasterCard, American Express, Diners
.
YES, I want to register now for the Musterion Seminar on 11 May 2004.
Participant's fee is (96,80 Euro, incl. VAT).
Name:
*
Function:
Company:
Department:
Street:
*
Number:
*
ZIP:
*
City:
*
Country:
*
Tel:
Fax:
E-mail:
*
Number of tickets:
1
2
3
4
5
6
7
8
9
10
(x 96,80 Euro) *
VAT number:
*
Mode of payment *:
Payment by creditcard
Payment upon receipt of invoice
* obligatory field
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