ISPE Milan Conferences - Kereon AG

ISPE Milan Conferences
Please return to:
ISPE Registration Services
Avenue de Tervueren, 300
B-1150 Brussels
Belgium
Tel: +32-2-743 4422
Fax: +32-2-743 1584
I. Delegate Information
Registration Form
ISPE Member: ❐ Yes, membership number
❐ No
Prefix: First Name: Mid Name: Last Name:
Job Title:
Company:
Address:
City: Postal Code: Country:
Telephone:
Fax:
Mobile:
E-mail:
Company VAT Number:
❐ I wish to keep my data confidential and it is given only for use by ISPE and its local Affiliates and Chapters.
❐ I do not wish my information to be printed in the Membership Directory or on Conference Attendee Listings.
MilConf2
II. Conferences Registration
Please select the conference you wish to attend (one conference per two-day event).
Prices below do NOT include VAT.
❐ Full Conference (28 November - 1 December). Please select below the
conferences you will be attending (one conference per two-day event)
28-29 November 2005
❐ Containment Technology Forum
❐ Sterile Product Processing for the 21 st Century
❐ Update on the Draft ISPE Maintenance Baseline ® Guide and Current
Maintenance Approaches in Industry
ST
30 November
❐ Infrastructure: Validation, Compliance and Control in a Global IT Environment
30 November - 1 December
❐
❐
Cleaning and Cleaning Validation
Risk Management and ICHQ9
1 December
❐ Global Information Systems: Validation, Compliance and Control in a Global IT Environment
ST
ST
* This nonmember rate entitles you to a one-year membership in ISPE at no additional charge.
** Proof of full-time student status is required.
❐ Please tick this box if you wish to become a Member. An ISPE Membership Application form will be sent to you, which
must be returned to ISPE within 30 days in order to activate your membership.
❐ First time attendee.
III. Social Evening
❐ Yes, I will participate in the ISPE Italy Affiliate Social Evening on Monday, 28 November (the cost per person is € 60).
Please indicate below the name of accompanying person.
First Name:
Last Name:
(for additional persons, please make copies)
Payment received
on or before 14 October
Member Nonmember*
€ 1540 € 1890 € 1990 € 2340 € 200 € 230 € 1020
€ 855 € 1035 € 1105 € 1285 € 100 € 130 € 510
€ 855 € 1035 € 1105 € 1285 € 100 € 130 € 510
€ 855
€ 450
€ 855
€ 855
Payment received
after 14 October
Member Nonmember*
IV. Method of Payment
20 % Italian VAT is applicable. Registrations will not be accepted without payment.
Sub-Total: €
ISPE Italy Affiliate Social Evening x € 60 €
20 % VAT: €
TOTAL DUE: €
❐ Credit Card: ❐ AMEX ❐ VISA ❐ EC/MasterCard
Credit Card number:
Cardholder’s name:
Signature:
Student**
Member Nonmember
€ 1035 € 1105 € 1285 € 100 € 130 € 510
€ 630 € 580 € 760 € 50 € 80 € 255
€ 1035 € 1105 € 1285 € 100 € 130 € 510
€ 1035 € 1105 € 1285 € 100 € 130 € 510
€ 450 € 630 € 580 € 760 € 50 € 80 € 255
Expiry Date:
V. Special Needs (dietary):
VI. Hotel Reservation
Please make the following reservation for me at the Milan Marriott Hotel, Via Washington 66, I-28146 Milan, Italy:
❐ Single € 160 / ❐ Double room € 180 (Including breakfast and taxes)
❐ Smoking / ❐ Non-smoking
(Subject to availability)
Arrival date:
Departure date:
Please guarantee my reservation with the following credit card: ❐ AMEX ❐ VISA ❐ EC/MasterCard
Credit Card number:
Expiry Date:
Cardholder’s name:
Signature:
VII. Signature
By signing, I agree with the ISPE Registration and Cancellation Policies (see page 21).
Date:
Signature:
Government
/Faculty