BRUSSELS TRAINING
ISPE 2012
Thon Hotel Brussels EU, Brussels
17 September – 20 September 2012
TRAINING SERIES
REGISTRATION FORM
Please return to: ISPE Registration Services
Avenue de Tervueren, 300 • B-1150 Brussels, Belgium
Tel: + 32 2 743 44 22 Fax: + 32 2 743 1584
E-mail: europeregistrations@ispe.org
SAVE TIME – REGISTER ONLINE: www.ISPE.org/2012-brussels-september-training
I. Delegate Information
Prefix:__________________ First Name:___________________________________________ Last Name:_ ___________________________________________
Job Title:______________________________________________________________ Company:____________________________________________________
Address:___________________________________________________________________________________________________________________________
City:____________________________________________ Postal Code:________________ Country:________________________________________________
Telephone:_ _______________________________________ Fax:_ _____________________________________
Company VAT number (mandatory):
Mobile:___________________________________________ Email:_____________________________________
__________________________________________
q I wish to keep my data confidential (only for use by ISPE and its local Affiliates and Chapters)
q I do not wish for my details to be printed in ISPE’s Membership Directory or on Conference Attendance Listings
II. Conference Registration
Prices below do not include VAT – 21% Belgian VAT is applicable on registration fees only.
Are you an ISPE Member? q Yes , membership number: _________________ q No
If you wish to become a Member of ISPE and benefit from lower registration fees, please select New Member registration fees.
€210 (VAT exempt) for your one-year membership is included in the New Member fees indicated below. If you do not wish to become a
Member of ISPE, please select the Nonmember fees.
q Tick here if you are a first time attendee
EARLY BIRD ON OR BEFORE
3 SEPTEMBER 2012
BRUSSELS TRAINING 2012
FACILITIES AND OPERATIONS
REGULAR / ONSITE
3 SEPTEMBER 2012
Member
New
Member
Nonmember
Member
New
Member
Nonmember
q Practical
Application of Computerised Systems Compliance (T11)
Two Day Course: Monday, 17 September and Tuesday, 18 September
€1.610
€1.820
€1.910
€1.810
€2.020
€2.120
qF
acility Project Management in the Regulated Pharmaceutical Industry (T26)
Two Day Course: Monday, 17 September and Tuesday, 18 September
€1.510
€1.720
€1.805
€1.710
€1.920
€2.015
q Turning QbD into a Practical Reality (T43)
Two Day Course: Wednesday, 19 September and Thursday, 20 September
€1.610
€1.820
€1.910
€1.810
€2.020
€2.120
qA
pplying Quality Risk Management (QRM) (T42)
Two Day Course: Wednesday, 19 September and Thursday, 20 September
€1.610
€1.820
€1.910
€1.810
€2.020
€2.120
MONDAY 17 SEPTEMBER – Thursday 20 SEPTEMBER, 2012
III. Method of Payment
(21% Belgian VAT should be included in the total payment, excluding €210 membership fee on New Member registrations)
Total Due: €________________________________________
q Credit Card Seminar Fees €______________________________________
21% VAT €__________________________________________
q Amex
q Visa
q Mastercard­
Credit Card Number: |—|—|—|—| |—|—|—|—| |—|—|—|—| |—|—|—|—|
Expiry Date: |—|—| / |—|—|
Cardholder’s Name:_______________________________________________________________________________ Signature:
IV. Special Needs (dietary or other):_________________________________________________________________________________________________
V. Hotel Information
Thon Hotel Brussels EU
Rue de la Loi 75
B-1040 Brussels, Belgium
Main Phone: +32.2. 204. 39.11
Reservations: +32.2.700.78.78
www.thonhotels.com/eu
Room rates:
Single room: €135 (Breakfast included)
Double room: €155 (Breakfast included)
(Rates include 6% VAT, service charge and buffet breakfast and
include city taxes of €6.40/room/night)
ISPE has secured a number of bedrooms at a fixed group rate for
your convenience. All accommodation bookings must be made
directly with the hotel and are subject to availability.
To benefit from the ISPE group rate, reservations must be received before
20 August 2012 and the official booking form must be used.
The Booking Form is available online at
www.ISPE.org/2012-brussels-september-training
The completed form must be returned directly to the Thon Hotel Brussels EU
by email to reservations@thonhotels.be or by fax to +32 2.205.15.25
VI. Signature
By signing I agree with the ISPE Registration and Cancellation Policies (see www.ISPE.org/2012-brussels-september-training)
Date:_______________________________ Signature: