Professional Documents
Culture Documents
Please use CAPITAL LETTERS or TYPE and return this form to:
conferences@efgcp.eu • Fax: +32 2 503 31 08
EFGCP Secretariat – Rue de l’Industrie 4, BE-1000 Brussels, Belgium - Tel.: +32 2 732 87 83 • www.efgcp.eu
Registration Details
Mr. Ms. Dr. Prof.
Family Name:.......................................................................... First Name:............................................................................
Position:.................................................................................. Department:...........................................................................
Organisation/Company:..........................................................................................................................................................
Address:..................................................................................................................................................................................
Zip code:..............................Town:......................................... Country:.................................................................................
Phone:.................................................................................... Fax:........................................................................................
Email:......................................................................................................................................................................................
Specific diet requirements (vegetarian, allergies …): …………………………....................................................................
If you need any other specific facilities (wheelchair access …), do not hesitate to inform the EFGCP Team.
Registration Fee
Become an EFGCP member when registering to this workshop and benefit from the discounted members’ rate
from now on (further details are available on the membership webpage).
Members of
+ VAT 21% Non-Members + VAT 21%
EFGCP-EFPIA
The registration fee includes workshop material, coffee breaks and lunch.
*I confirm my following membership is valid:
EFGCP–Individual EFGCP–Institutional EFGCP–Corporate EFPIA
Representatives of EFGCP Institutional and Corporate Members may directly benefit from the EFGCP Members’ rate (check if your
organisation is a member on www.efgcp.eu).
PATIENT ORGANISATIONS: benefit from a waiver or one of the 10 grants available to fund your participation in the workshop. Contact
the EFGCP Team.
Cancellation Policy
All cancellations must be in writing. Cancellations received before 7 May 2015 are subject to a charge of 25% of the
registration fees for administrative costs. From 7 May 2015 on, full payment will be requested and refunds will not be
provided. Replacements by colleagues, i.e. transfer of the registration at no extra cost, are much welcome.
EFGCP Multi-Stakeholder Workshop, 29 May 2015, Brussels, Belgium – Participant Registration Form p. 1/2
Way of Payment
BANK TRANSFER All charges to be borne by principal, to the order of the EFGCP.
Account
EFGCP Events Bank Name: ING, Brussels, Belgium BIC/Swift BBRUBEBB
Holder:
Invoice #
Account #: 310-1960818-49 IBAN: BE97 3101 9608 1849 Communication Delegate’s
name
For payments by Bank Transfer: to comply with new EU invoicing rules as of 01/01/21013, a pro forma invoice will be sent
along with the confirmation of registration. Once payment is received (prior to the event!), the official invoice will be issued.
For payments by Credit Card: The official invoice will be sent upon receipt of payment from the Credit Card operator.
EFGCP Multi-Stakeholder Workshop, 29 May 2015, Brussels, Belgium – Participant Registration Form p. 2/2