APPLICATION
Executive Master in Digital Marketing
2015
This completed form together with your CV
should be sentto the following address before
31stOctober 2015:
Thierry Antoine, Coordinator
Executive Master in Digital Marketing
Solvay Brussels School of Economics and Management, ULB
Avenue Franklin Roosevelt, 42 (R42) - CP114/01
1050 Brussels
Phone: +32 (0)26504145
Enroll before 30thSeptember 2015 and receive a 15%
discount.
Personal details
❏Mr ❏Mrs ❏Ms
Surname...... First name ......
Date of birth...... / ...... / ...... Place of birth......
Nationality ......
I wish to receive documents at my: ❏ private address❏professional address
......
Tel...... Mobilephone ...... E-mail ......
Academic education (enclose copies of qualifications obtained):
Marketing and advertising seminars attended:
Languages:
French
English
Professional experience
Your current employer ...... Company name......
Address......
Tel ...... Fax...... E-mail ......
Number of staff ...... including executives...... office staff...... manual workers…………
Turnover:......
Description of the sector and type of business: …………………………………………………………………………………
…………………………………………………………………………………………………………………………………….
Your current position (detailed description): …………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….
Start date: ...... (attach organisation chart)
Your previous employers (company name, position, duration):………………………………………………………………….
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
Objectives: why do you wish to enrol in this programme?
......
......
......
Personal interests/activities: …………………………………………………………………………………………………......
…………………………………………………………………………………………………………………………………….
Course fees will be paid by the employer ❏ yes❏ no
Invoice under the reference......
For the attention of ......
VAT No ......
Participants mustregularly attend their courses for this programme (at least at 80% of classes) and produce a written dissertation which will be presented orally before a juryand complete their internship in order to be awarded the “Executive Master in Digital Marketing”.
The undersigned company (or the participant in the event of individual registration) undertakes to pay the registration fee for theExecutive Master in Digital Marketing at €7,950 excl. VAT (€9.619 incl. VAT) which shall be paid into the ASBL B.M.M.A account no BE45 2100 3073 3389 with the statement“name + EMDM NOV 2015”.
❏I enrolled before 30thSeptember 2015 and I claim my right to a 15% reduction if the payment is made within 8 days from the reception of the invoice: I shall therefore pay the amount of €6,750 excl. VAT (€8,167 incl. VAT)
The next session will begin on 13November 2015. Classes will be held in building (R42) of the Solvay Brussels School of Economics and Management at 42 Avenue Franklin Roosevelt, UniversitéLibre de Bruxelles.
How did you hear about the Executive Master in Marketing & Advertising?
❏Student or participant ❏Friend❏Colleague ❏Teacher❏Post/Mailshot❏E-mail ❏Google/Search engine
❏Website (please specify): ...... ❏Press (please specify): ......
❏Public event/Fair/Forum (please specify): ......
❏Other (Twitter, Facebook, etc.): ………………………………………………………………………………………………
General conditions
The payment must be made in its entirety before the first lesson.
Any participant who leaves after the programme has started must note that they will be liable for the entirety of their registration fee.
Any cancellation must be communicated in writing. Depending on the date of notification, the following measures will be applied:
a) More than 30 days before the first day of lessons: no registration fee is due.
b) Less than 30 days before the beginning of lessons: the sum of €1,000 shall be paid for administrative fees (this
sum is deductible from the registration fee for the following year, should the student take up their studies next year).
Date: ………………………………………………./2015
Signatures: ¨Participant: Company: Company stamp:
(name and title) (name and title (proving consent
of the person responsible)to payment)