Dear xyz, - Alfi

alfi.lu

Dear xyz, - Alfi

AIFM Directive – ImplementationAn ALFI Leading Edge ConferenceChambre de Commerce, Kirchberg, LuxembourgTuesday 09 July 2013CREDIT CARD PAYMENT FORMPlease complete and fax to: + 31 (0)20 572 73 77ALFI/AIMA/LPEA MembersNon- MembersFees*:Early bird rate** Normal rate Early bird rate**: Normal rate:€ 250 € 300 € 550 € 650CompanyName Participant:Amount due*: EUROFirst name & Lastname:(as on credit card)Company:Address:Zip-code, City:State/Country:E-mail:I hereby allow you to charge my credit card directly.I hereby allow you to charge my credit card if the amount above has not beencredited on your bank account by 16 th July 2013.Please charge my: American Express VISA Euro card / Master card DinersName on CreditCardCredit Card Number:Security Code:(last 3 digits on the reverse back side of your card) _ _ _Expiry Date:Date:..…… /……………./ 2013…… / ……..Signature:……………………………………………………………………………………*Subject to correction by registration office, if applicable.5

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