BIO '99
INTERNATIONAL

REGISTRATION FORM

Please return to:
FIP Congresses & Conferences
P.O. Box 84200, 2508 AE The Hague (The Netherlands)
Tel: +31-70-302 1982, Fax: +31-70-302 1998, E-mail:
mireille@fip.nl

Please type or use capital letters

Name:...............................................................................................Title:.................................

Address:.....................................................................................................................................

Code:.....................................................City:...............................................................................

Country:................................................Phone:..........................................................................

Fax:.......................................................E-mail:...........................................................................

Registration fees (incl. 17,5% VAT):

Registration Fee
(all prices quoted in NLG)
before 1 June '99
(NLG)
after 1 June '99
(NLG)
on site
(NLG)
Participant 1.530 1.765 2.000
Student 470 590 590
Day card 825 825 825


Card no:................................................................................................................................

Cardholder's name in block letters:....................................................................................

[ ] Diners Expiry date:...............................................................
[ ] American Express
[ ] EuroCard/MasterCard
[ ] Visa
Total NLG:................................................................
Date:......................................................Signature:.................................................................

Registration is not valid without payment.
Do not forget to make a copy of this card for your own use.

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