I register for the Rencontres de la Ruhr



I will be present from  to

You represent



Your personal data



Civility : First name : Surname :
Position : Name of local government/organisation :
Address :
Postal code :
City :
Country :
Telephone : Mobile :
E-mail : Fax :

Accompanied by



Civility : First name : Surname :


A fiancial participation will be asked for meals and cultural activities

Travel



Arrival in Essen : Time :
Departure from Essen : Time :

Accommodation



Please reserve a room from to

Hotel Ibis Essen
InterCityHotel Essen

in room single double twin

Payment



I pay for my registration fees up to the amount of euro

I ask Les Rencontres to invoice my hotel expenses for the amount of euro

I will pay for my hotel expenses myself in Essen euro, by bank transfer *


Please specify the name, title, service, address, tel. and email of person the invoice should be sent to :
* Without bank charges for the payee. All tranfer charges and commission costs are to be borne by the payer. Please make sure you clearly indicate the reason of your payment so that our accountant can identify it.

Performances and visits



1 - Cultural activity of Friday, 15 October (evening)
2 - Visits of Saturday, 16 October (afternoon)
3 - Cultural activity of Saturday, 16 October (evening)

Meals



1 - Reception of Thursday, 14 October
2 - Lunch of Friday, 15 October
3 - Dinner of Friday, 15 October
4 - Lunch of Saturday, 16 October
5 - Dinner of Saturday, 16 October

Debats



I would like to give a speech during the round table :

I wish to speak in :

Message :

Insurancy



I certify that I have a valid and appropriate insurance policy for my travel and stay.