CIE Division 2 meetings 2018 participation form Form for participation in CIE Division 2 meetings Title* First name* Family name* Affiliation* Address* Country* Email* Email confirmation* Phone NumberI like to attend:**I like to attend:*Seminar of June 12th 2018, costs € 105,-Div 2 meetings 13th - 15th June, costs € 120,-Div 2 meetings 13th - 15th June + Dinner, costs € 170,-Seminar and Div 2 meetings, costs € 225,-Seminar and Div 2 meetings + Dinner, costs € 275,-Membership*Yes, I am a CIE National RepresentativeNo, I am not a CIE National RepresentativeYes, I am a NSVV memberNo, I am not a NSVV memberPayment methodBancontactBankoverschrijvingBelfius Direct NetCreditcardiDEALKBC/CBC-BetaalknopPayPalSOFORT BankingComments/questions“Let us know if you have any specific information like dietary requirements”.EmailDit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.