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Registration form NA Directors meeting April 21- April 23 (Brussels)
Name
*
Surname
*
Organisation
*
E-mail address
*
Phone number
*
Date of arrival
*
MM slash DD slash JJJJ
The official program starts on April 21 with dinner at 07.00 pm and ends on April 23 after lunch. If you plan to arrive earlier we can help reserve an additional night (April 20-21). The price is XXX Euro and payment is to be made directly to the hotel upon check-out. Please note that in case you can’t attend, you must cancel your reservation via XXX@gmail.com by March XXX at the latest, otherwise you will be charged the amount stated above.
Date of departure
*
MM slash DD slash JJJJ
Do you have any dietary requirements and/or allergies?
*
Yes
No
If so, which requirements and/or allergies do you have?
On Sunday April 21, approximately at 04.00 pm, a guided Tour by foot in Brussels is organized.
*
I will attend this tour
I will not attend this tour
If you attend this tour, do you need any assistance related to mobility issues?
Describe what kind of assistance you need.
By registering to this event I consent that my full name, organisation and e-mail address is shared with the other participants at the event and that my contact details may be used by the organisers to share relevant information about this event.
*
I agree
Conditions
*
I agree with the
Epos privacy statement
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