Registration Form Water Association européenne

Registration form
9th EWA Brussels Conference
„Water – Investing Today for the Future“
13-14 November 2013 Brussels, Belgium

Please complete the form and send it by email
or fax to the Conference Secretariat before
31st October 2013

EU Policy Workshop “How to deal with
Brussels”
15 November 2013 Brussels, Belgium

Mrs. Mona Lorvik:
Fax: + 49 2242 872 135
Email: Lorvik@ewa-online.eu

Personal Information (please type or print clearly in CAPITAL LETTERS)
* all fields marked with a star are required for the registration
* Title

☐Mr.
X

☐Mrs.

☐Ms.

Academic Title

☐Prof.

☐Dr.

☐Other (Please Specify_____________)

* NAME, First name
* Organisation
* Postal Address
* Postal Code
Tel./Fax:
Email:

D'Alexandris Jean Marius
lyseconcept
103 rue Ernest Renan
83000 TOULON
+330603658726
lyseconcept@gmail.com

* Registration Fee (Please note that the prices exclude VAT as the EWA is exempt from paying VAT!)
(the registration fee includes your participation at the conference or/and workshop including coffee and lunch breaks and participation at
the Dunbar Award Ceremony)

I want to register for

☐the Conference
Conference

460 EUR
☐Delegate
415 EUR
☐Delegate Early Bird
350 EUR
☐EWA Member
315 EUR
☐EWA Member Early Bird
Early bird registration until 9th August 2013

☐the Workshop

☐both

Workshop

Both events

390 EUR
350 EUR
320 EUR
289 EUR

635 EUR
570 EUR
500 EUR
450 EUR
th

☐I will participate at the Dunbar Medal Award Ceremony and Dinner on 13 November 2013
*Payment method (Please specify by which method you wish to pay your registration fee)
☐ Bank transfer
☐Credit Card
With Credit Card: (we accept only VISA and MasterCard)
Card type: ☐ VISA
☐MasterCard
Credit card’s holder (enter as written on the credit card):
Credit card number:
Expiry date:
M

Security code (the 3 last digits on the back of the credit card):
Y

Cancellation Policy (Please read carefully): Participation fee (minus 25% administration fee) will only be reimbursed if the
participant announces this in writing and the cancellation has reached the registration office by 31st October 2013; 14 days prior to the
conference (indicated by the postmark or date of email). In all other cases—including non-appearance at the conference—the full
participation fee has to be paid. After informing the office, a substitute can be sent.
By registering to the conference the delegate has acknowledged and agreed to the above mentioned cancellation policy.