REGISTRATION FORM

(PAPER)

  1. YOUR COMPANY

Name:

Phone*:

Fax:

Address*

Street and number:

Postal code:City: Country:

Website (if applicable):………………………………………………………………

Note: This information will be available to public

INFORMATION ON THE COMPANY:

Number of employees*:

Date of creation:

Activity sector* (NACE reference list. Rev.2):

A AGRICULTURE, FORESTRY AND FISHING
B MINING AND QUARRYING
C MANUFACTURING
D ELECTRICITY, GAS, STEAM AND AIR CONDITIONING SUPPLY

E WATER SUPPLY; SEWERAGE, WASTE MANAGEMENT AND REMEDIATION ACTIVITIES
F CONSTRUCTION
G WHOLESALE AND RETAIL TRADE; REPAIR OF MOTOR VEHICLES AND MOTORCYCLES
H TRANSPORTATION AND STORAGE

I ACCOMMODATION AND FOOD SERVICE ACTIVITIES
J INFORMATION AND COMMUNICATION
K FINANCIAL AND INSURANCE ACTIVITIES
L REAL ESTATE ACTIVITIES
M PROFESSIONAL, SCIENTIFIC AND TECHNICAL ACTIVITIES

N ADMINISTRATIVE AND SUPPORT SERVICE ACTIVITIES
O PUBLIC ADMINISTRATION AND DEFENCE; COMPULSORY SOCIAL SECURITY
PEDUCATION

Q HUMAN HEALTH AND SOCIAL WORK ACTIVITIES
R ARTS, ENTERTAINMENT AND RECREATION
S OTHER SERVICE ACTIVITIES
T ACTIVITIES OF HOUSEHOLDS AS EMPLOYERS; UNDIFFERENTIATED GOODS- AND SERVICES-PRODUCING

ACTIVITIES OF HOUSEHOLDS FOR OWN USE
U ACTIVITIES OF EXTRA TERRITORIAL ORGANISATIONS AND BODIES

Note: This information will be used only for statistical purposes

Short description ofthe company in English. (max. 50 words):

Annual turnover* (in €)…………………………………………………………………...

of which total export: (in €) -To EU countries: ………………………….

-To non EU countries: …………………….

Note: This information will be used only for statistical purposes

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EPE 2010 Registration Form – March 2010

II. YOUR PROFILE

Title*: Mr. Ms. Mrs. Miss Pr. Dr.

First name*:

Family name*:

Position within the company/organization*:

Note: This information will be available to public

Date of birth*:

Nationality*:

Note: This information will be used only for security purposes

Spoken languages*:

E-mail address*:

Office phone*:

Mobile:

Fax:

Person of contact (if any):

First name/Last name:

Position:

Office phone:

Fax:

Your Chamber of Commerce*:

Note: This information will be used only for administrative purposes

ADDITIONAL INFORMATION:

Are you willing to be part of EUROCHAMBRES’ Polling Panels in future?

YES NO

Are you willing to sign up to EUROCHAMBRES’ Monthly Newsletter?

YES NO

PRIVACY PROTECTION*:

To comply with the provisions of the Belgian law of 8 December 1992 on the protection of private life, participants will have to provide EUROCHAMBRES with their formal agreement. Therefore, it is important that the registration form should be duly completed and signed.

Do you agree to be included in the list of the participants to be published on the EPE website (information available to public)?

YES NO

Signature of the participant: Date:

NOTE: Confirmation of participation will be sent on behalf of EUROCHAMBRES

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EPE 2010 Registration Form – March 2010

CONTACTS:

For processing of your data:

EPE 2010 National Coordinator

Mr. Georgi Stoev or

For general information on the event:

Ms. Irina Tikhonova: or

For legal inquiries:

Mrs. Catherine Pham:

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EPE 2010 Registration Form – March 2010

 Fields marked with asterisk are compulsory