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Name:
First name:
transfers 50 % of the entire amount for the course. The remainder amount I will pay on the first day of the course.

Course
         Per course-year: 850 EUR

     LIVE-CASES

for 10 coupons : 630 EUR, facultative : 70 EUR

 

Because of organizing reasons the registration has to be done before the course start date.

50 % of the entire amount of the course must be transferred immediately after registration at the bank account  number:
784-5211485-89 of the Dexia-Bank. Don’t forget to mention your name, address and year of the course.

Your registration will be official when you have completed and sent this official registration form, your curriculum vitae, the statement of professional secrecy and the appropriate payment of 50 % of the entire amount of the course.

Fees and deposits are not refundable for withdrawal of the course.

Please note that we do not accept Eurocheques, Bancontact, Mister Cash, Eurocard or Visa.
 
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Name:
First name:
Nationality:
Date of birth : . .
Occupation:
Address:

Privat:

Street:

Zip/City:

Country:

Tel.:

Fax:

email:


Work:

Street:

Zip/City:

Country:

Tel.:

Fax:


Studies and certificates:
   

Print out your STATEMENT OF PROFESSIONAL SECRECY.
 
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