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
Registration Information
SAVE TIME – REGISTER ONLINE: www.ispe.org/2012gampeuconference
I. Delegate Information
Prefix: ________ First Name:_______________________________________ Last Name: ___________________________________________________________
Job Title: ________________________________________________________ Company: ____________________________________________________________
Address: ______________________________________________________________________________________________________________________________
City:____________________________________________________________ Postal Code: ___________ Country: ______________________________________
Telephone: ______________________________________________________ Fax: _________________________________________________________________
Mobile: _________________________________________________________ Email: ________________________________________________________________
Company VAT number (mandatory): ______________________________________________________________________________________________________
❑ I wish to keep my data confidential (only for use by ISPE and its local Affiliates and Chapters)
❑ 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? ❑ Yes, membership number______________________ ❑ 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.
❑ Tick here if you are a first time attendee
REGISTRATION FEES
(discounts cannot be combined)
GAMP European Conference
ON OR BEFORE 3 SEPTEMBER 2012
Wednesday 19 September –
Thursday 20 September, 2012
Member
New
Member
Nonmember
Board &
Committees
Member
New
Member
Nonmember
Board &
Committees
Track 1: Electronic Laboratory
Notebooks
€1.395
€1.605
€ 1.685
€700
€1.595
€1.805
€ 1.895
€ 700
Track 2: Information Technology
€1.395
€1.605
€ 1.685
€700
€1.595
€1.805
€ 1.895
€ 700
Track 3: Sustaining and Improving Compliance
€1.395
€1.605
€ 1.685
€700
€1.595
€1.805
€ 1.895
€ 700
AFTER 3 SEPTEMBER 2012
III. Method of Payment
(21% Belgian VAT should be included in the total payment, excluding €210 membership fee on New Member registrations)
Conference Fees:
21% VAT:
Total Due:
❑ Credit Card:
❑ AMEX
❑ VISA
€
€
€
❑ 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 made before 20
August 2012 and the official booking form must be used. The Booking Form is available
online at www.ISPE.org/2012gampeuconference
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/2012gampeuconference)
Date: ___________________________________ Signature: