PHYSMOD 2009

Registration

Symposium Fee

The amount of the symposium fee is 175 Euro. Accompanying persons will have to pay an additional amount if participating to the banquet on August 25th. The sum is 50 Euro per person.

Registration form

All fields with a * are mandatory. If it's not applicable for you, write "none" in the concerned field.
Title of Lecture Series*:
Mr / Mrs:
Name*:
Firstname*:
Nationality*:
Name and full Address of Company, Institution or University*:
VAT Number of your company / your university*:
Position or title:
Telephone nr*:
Fax nr*:
e-mail*:
Undergraduate student
Ph.D. Candidate or University assistant not having a Ph.D.
Others
Number of accompanying persons* (put 0 if none):

Hotel reservation

VKI secretariat can book rooms upon request in the recommended hotels. Daily rates include all charges and continental breakfast. These prices are indicative and could be subject to changes. However, participants could occasionally find special offers on hotel websites. If you book a hotel on your own, please be sure it is near the VKI bus location at Place Rogier.
(If applicable) I require accommodation at hotel
for person(s)
Single
Double
Date of arrival:
Date of departure:
I shall require transport to and from the Institute
I do not require transport to and from the Institute
Please indicate any special needs (e.g. vegetarian, ...):

Methods of Payment

Payment should be preferably done 2 weeks prior to the beginning of the symposium. Payment must be the equivalent of the fee at the prevailing rate of exchange. Only two methods of payment are accepted:

• 1. By bank transfer to our account Nr 210-0315330-35 at Fortis Bank, avenue de la Forêt de Soignes 322, 1640 Rhode-Saint- Genèse, Belgium. Indicating clearly the name of the participant and symposium title.
  IBAN BE57 2100 3153 3035
  SWIFT CODE: GEBABEBB 36A
• 2. Or by returning a copy of this invoice with the following information to the VKI administrative office (e-mail: vanhaelen@vki.ac.be, FAX: +32 2 359 96 00).