31
St
may
2013
afternoon
Brussels
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CONTACT
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1-Your CONTACT INFORMATION
Name
*
:
Firstname
*
:
Email
*
:
Phone :
GSM :
Language
*
:
FR
NL
UK
Function
*
:
Company
*
:
Street
*
:
NR/Box
*
:
Postal Code
*
:
City
*
:
I'm a member of BeCommerce
Yes
No
I'm a member Feweb
Yes
No
I'm a member BDMA
Yes
No
I'm a member BDMA
Yes
No
VAT number BE 0
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2-Contact information of your guest
Name :
Firstname :
Email :
Company :
Function :
3-INVOICING ADDRESS
(only if different from STEP #1 )
Company invoice
Street :
NR/box :
Postal Code :
City :
Your references :
VAT number BE 0
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5-Entry fee
350 Euros
(Excl.VAT)
315 Euros
(Excl.VAT) for BeCommerce member.
If you want more than 3 reports, please contact
pascale@best.be
6-PAYMENT
I pay by card (secured payment)
You will maybe have to use your DIGIPASS if your bank requires it!
I would like to pay by bank transfer.