Online registration form

Meeting
registration

Yes I would like to attend the meeting

I will attend the upcoming LES Benelux Topic Meeting on
Date
Date Format: DD slash MM slash YYYY
Name
First Last
Gender
- Male
- Female
Company
Address
Street Address City ZIP / Postal Code
Phone
Email
LES
- Member
- Non member
Is your age 40 or below
- Yes
- No
Date of Birth
Date Format: DD slash MM slash YYYY
VAT number
LES Benelux is not liable to VAT
At live events fees include coffee and tea in the breaks, lunch and drinks after the meeting.

You will receive a confirmation and invoice if applicable upon registration.

Please note that cheques will not be accepted, but at the meeting payment can be made by credit card (Visa and Mastercard).

By completing and sending this electronic registration form I know and agree that cancellations must be received in time before the meeting takes place in order not to be charged for the full meeting costs.
Email
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