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Collecting War

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COLLECTING WAR

TRENCH ART AND SOUVENIRS - MANUFACTURE AND REPRESENTATION International Conference

Registration Form

Name & First Name Address

Tel. Fax

E-mail

Please tick the appropiate box(es)

❏

Attendance Friday 17 April, excl. conference dinner 25 euro

❏

Attendance Friday 17 April, excl. conference dinner 20 euro (VIFF*)

❏

Attendance Saturday 18 April 30 euro

❏

Attendance Saturday 18 April 25 euro (VIFF*)

❏

Attendance full conference, excl. conference dinner 50 euro

❏

Attendance full conference, excl. dinner 40 euro (VIFF*)

❏

Attendance full conference, incl. conference dinner 105 euro

❏

Attendance full conference, incl. conference dinner 95 euro (VIFF*)

❏

Conference Dinner only 55 euro

❏

Vegetarian Total amount due

Lunch(es) and coffee break(s) included.

The registration will be considered defi nitive once the payment of the amount due has been received.

❏

I will pay with VISA** Card number Expiry Date

Name of Card holder

❏

I will pay by transfer of the amount due into the account of the In Flanders Fields Museum Account number (Belgium) 068-2170187-33

Swift Code/BIC: GKCCBEBB

(Bank details: Dexia, Kerkplein 18, B-8908 Ieper) Account N° (international): IBAN: BE79 0682 1701 8733 Remarks/comments/special wishes

Signature

Please return this registration form by 1 April 2009 to Dominiek Dendooven, In Flanders Fields Museum, Janseniusstraat 9, B-8900 Ieper, fax: 0032 (0) 57 239 459, e-mail: Stedelijke.Musea@ieper.be

*Friends of the In Flanders Fields Museum

** This information will be handled strictly confi dential. Card number will be erased immediately after transfer.

I will pay with VISA** Card number Expiry Date

Références

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