Euromeeting 2017 - Resgistration Form

Euromeeting 2017 in Luxembourg

Please fill in the form below.
Full Name*

First NameLast Name
RT Position*
RT number & name (e.g. RT5 Luxembourg-Moselle)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Mobile Phone Number*

Country CodeArea CodePhone Number
Office Phone Number*

Country CodeArea CodePhone Number
Full name of partner (if applicable)
Your Participation
Please choose your participation package

Pretour & EuromeetingEuromeeting
Arrival Information
Day of Arrival

DayMonthYear
Time of Arrival

:HourMinutes
Arrival by

AirplaneTrainBus / CoachCarOther
Flight, Train or Bus No. (if applicable)
Departure Information
Day of Departure

DayMonthYear
Time of Departure

:HourMinutes
Departure Details

AirplaneTrainBus / CoachCarOther
Flight, Train or Bus No. (if applicable)
Special dietary requirements
Any other remarks
Payment Options
Bank Wire Transfer - Information:
BIC/Swift: XXXXXXXX

IBAN: LUXX XXXX XXXX XXXX XXXX
Account holder: Table Ronde 5 - Moselle

Any bank fees caused by the wire transfer are at your charge.
Should be Empty: