A. Participant

Ms Mrs Mr Dr Prof

Valid

Valid


private address / institute address

Valid

Valid

Will participate in the congress dinner Thursday 2. April 2009


B. Extra costs

 

 EUR 25,--

 EUR 34,--

 EUR ..,..


 

 EUR 25,--

 EUR ..,..

 EUR ..,..


C. Payment

 EUR ..,..

 I have transferred the amount of EUR on date Valid  to your bank:

account number 15.58.104

Stichting Nationaal Schoolmuseum
Postbus 21536
3001 AM Rotterdam
Netherlands

NL84INGB0003708758

INGBNL2A