Inschrijven - Registration IC2BE

 
Achternaam - Surname * 
Voornaam - First name * 
Functie - Job title * 
Bedrijf - Company/organization * 
Adres - Address * 
Postcode - Postal code * 
Stad - Town/City * 
Land - Country * 
Telephone no. * 
E-mail *   
Facturatiegegevens - Billing address:
Naam - Name
Adres - Address
Postcode - Postal code
Stad - Town/City
Land - Country * 
BTW - VAT  

Ik schrijf in voor - I register for


 
Totaal verschuldigd bedrag - Total amount due: €

Betaling is verschuldigd na ontvangst van de debetnota die u via e-mail zal ontvangen.
Payment will be done after receipt of the invoice which will be sent to you by e-mail.
*  required fields
IC2BE (reinhilde.tulkens@uantwerpen.be) is collecting these details in order to organise activities. Under no circumstances will your contact details be passed on to third parties. If you would like to change or remove your personal details, please contact the address above. More information about our privacy policy: www.uantwerpen.be/disclaimer.