Online Registration Photonics21 Annual Meeting 2012

Venue:
Hotel Husa President Park,
Boulevard du Roi Albert II, 44
1000 Bruxelles

Date:
27 & 28 March 2012

Registration fee:
180 €, VAT included, covering entrance to all sessions, lunch, coffee breaks and the evening reception. The amount of 180 € will automatically be debited from your credit card.

Name *
First Name *
Organisation *
Company seat or tax representative in Belgium *	Yes No
Belgian Tax Number *
VAT ID Number *
Function *
Billing Address * street & nr, P.O. box
Additional address information company name, c/o
City *
Postal code *
Country *
Phone *
E-mail *
Retype E-mail *
Please select if you are a member of the Photonics21 Executive Board Photonics21 Board of Stakeholders Press Mirror Group Speaker Sponsor (1 free entry per sponsor)
Please select if you would like to attend the Evening Reception on the 27 March 2012, 19.00 - 22.00 General Assembly + Work Group Sessions on the 28 March 2012, 9.00 - 17.00
Please select the afternoon Work Group session on the 28 March 2012 you would like to participate in * WG1 - Information & Communication WG2 - Industrial Manufacturing & Quality WG3 - Life Science & Health WG4 - Emerging Lighting, Electronics & Displays WG5 - Security, Metrology & Sensors WG6 - Design and Manufacturing of Components & Systems WG7 - Photonics Research, Education & Training
Payment *
Payment may be either made by VISA, MasterCard or American Express. Payment will be processed by a professional payment service provider (COMPUTOP GmbH) which is verified by above mentioned credit card companies. The payment process is encrypted by SSL in order to keep your credit card data strictly confidential.

*mandatory fields

Please note that a cancellation of your registration and reimbursement of the registration fee is only possible until the 28 February 2012.