Registration form Special Session PROS members

(ThursdayJune 5th - € 300,- per person per day)

Pleasecomplete the form and email/fax itto:

Royal Dutch Society of Engineers, email: ; tel: +31-70-3919890;

fax: +31-70-3919840

First name *
Initials * (R.P.F.)

Prefix (van der)

Surname * (Berg)

Titles (Dr.)

Male/FemaleMale Female

Name on badge *

(Name on badge 2nd line)

Organization *

(Organization 2nd line)

Street * (Park Avenue)

House number (numeric part) (23)

House nr (alphanumeric part) (Bis)

Postal code/ZIP-code(9171)

City * (Paris)

District/Province/State(P.E.I.)

Country *

Location(Researchbuilding/Room)

Email *

Telephone

Fax

Pleasetickthe topics you are most interested in: / / Clean andEfficient Engine Technologies
/ New Energy Powertrains
/ TransmissionsandHybrids
/ LightweightSolutions
/ AutomatedandCooperativeDriving
/ Advanced Safety Technologies
/ Vehicle Dynamics and Intelligent Vehicle Controls
/ NoiseVibrationandHarshness (NVH)
/ Automotive Human Factors
/ New Mobilityand Vehicle Concepts
/ Executive track
/ Educators Seminar & Educators Technical Session
Ifyourequire a letter of invitationfor visa purposespleasetickthis box.

MainProgramme

Date / Time / Cost
/ Conference dinner / 4-6-2014 / 20:00-23:00 / EUR 95,-
/ Technical Tour 1 AutomotiveCampusNL/Inalfa/DAF / 6-6-2014 / 9:00-17:00 / EUR 50,-
/ Technical Tour 2 RWTH Aachen Un. (IKA) / 6-6-2014 / 9:00-13:00 / EUR 50,-
/ Technical Tour 3 Umicore Belgium / 6-6-2014 / 9:00-13:00 / EUR 50,-
/ Daytripto Aachen / 3-6-2014 / 9:00-17:00 / EUR 80,-
/ Half Day guidedwalking tour Maastricht / 3-6-2014 / 14:00-17:00 / EUR 50,-
/ Daytripto Brussels / 4-6-2014 / 9:00-17:00 / EUR 80,-
/ Half Day excursion Cave St. Pietersberg / 4-6-2014 / 10:0013:00 / EUR 50,-
/ Daytripto Amsterdam / 5-6-2014 / 9:00-19:00 / EUR 80,-
/ Half Day excursionHoensbroekCastle / 5-6-2014 / 9:00-12:30 / EUR 50,-
Order numberon invoice (ifapplicable) /
Ifyourequire a purchase order number or otherreferencetoprocesspaymentbyinvoiceplease enter yourpurchase order number or referencehere
Special dietaryrequests
Name of Accompanying Person (ifapplicable) (name on badge) / (costs € 95,00)
Date / Time / Cost
/ Conference dinner / 4-6-2014 / 20:00-23:00 / EUR 95,-
/ Technical Tour 1 AutomotiveCampusNL/Inalfa/DAF / 6-6-2014 / 9:00-17:00 / EUR 50,-
/ Technical Tour 2 RWTH Aachen Un. (IKA) / 6-6-2014 / 9:00-13:00 / EUR 50,-
/ Technical Tour 3 Umicore Belgium / 6-6-2014 / 9:00-13:00 / EUR 50,-
/ Daytripto Aachen / 3-6-2014 / 9:00-17:00 / EUR 80,-
/ Half Day guidedwalking tour Maastricht / 3-6-2014 / 14:00-17:00 / EUR 50,-
/ Daytripto Brussels / 4-6-2014 / 9:00-17:00 / EUR 80,-
/ Half Day excursion Cave St. Pietersberg / 4-6-2014 / 10:0013:00 / EUR 50,-
/ Daytripto Amsterdam / 5-6-2014 / 9:00-19:00 / EUR 80,-
/ Half Day excursionHoensbroekCastle / 5-6-2014 / 9:00-12:30 / EUR 50,-
Special dietaryrequests partner
Additional information

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