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Registration Millennium Jam 2010
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| Name |
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| Surname |
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| Artist name |
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| Company |
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| VAT n° |
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| Adresse |
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| Postcode |
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| City |
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| Land |
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| Tel |
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| Fax |
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| Web |
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| Email |
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| Email (comfirm) |
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| 1-day |
65 EURO pp + VAT |
| 2-days |
120 EURO pp + VAT |
| 3-days |
165 EURO pp + VAT |
| 5-days |
199 EURO pp + VAT |
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Diner + Gala on Saturday 06/11/2008
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Yes , I wish to take part in the diner+gala at 50 EURO + VAT PP
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Payment
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| Cheque - IBS |
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| Creditcard |
Euro/Mastercard Visa |
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Number
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exp |
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Name
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| Transfer bank |
KBC Bank - Grote Markt 27 B-2800 Mechelen
IBAN : BE64414001020152
BIC : KREDBEBB |
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KBC Bank - Watermanweg,92 NL-3067 GG Rotterdam
IBAN : NL64KRED0633139262
BIC : KREDNL2X |
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Remark :
Fill in this form and send it online or send it by mail or fax:
IBS NV 46,Hoge Velden B-2860 St-Katelijne-Waver Belgium
Tel++32 15294429 - Fax++32 15294422 - TMJ hotline++32475 231699
WWW.MILLENNIUMJAM.COM INFO@MILLENNIUMJAM.COM
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