and writing
at UNESCO, Paris, 3 – 5 February, 2010
REGISTRATION FORM(To be returned to Dyslexia International)
Complete this page please in UPPER CASE LETTERS, and
Either fax it to:0032 2 537 7066
Or email it to:
First name(s): ______
Last name(family name): ______
Title (Mr, Mrs, Ms, Dr, other): ______
Postal address: ______
______
Post code: ______Country: ______
Organisation (optional): ______
Telephone number (including country code): ______
Fax number (if different): ______
GSM: ______
Email: ______@ ______
First language: ______
Preferred second language (English or French): ______
Special dietary requirement: ______
□Tick the box to confirm you have read and accept the conditions for cancellation on Page 2.
□Tick this box if you need information about favourable rates for hotels.The hotel is not included in the registration fee.
□ Tick this box if you require us to support an application for a visa.
PAYMENT(Please keep this page.)
The Forum fee is € 450,00per person(four hundred and fifty Euros, no cents).
The fee pays for room and equipment hire, speakers’ costs, interpretation, logistics, printed materials for the participants, organizing staff, coffees/teas and light luncheon refreshments for two days.
The Forum is being organized by Dyslexia International, a charitable organisation which depends on voluntary contributions and sponsorship.
International bank transfer:
Please ask your bank to transfer the fee to:
Dyslexia International ASBL, Rue Defacqz 1, B – 1000 Bruxelles, Belgique
Bank:ING Belgique SA, Avenue Marnix 24, B – 1000 Bruxelles, Belgique
IBAN: BE52310194089309 BICC (SWIFT): BBRUBEBB
NOTE 1: Please make sure bank transfer charges are covered by you as payer.
NOTE 2: Please make sure that we can identify you personally from the Communication line (‘Additional information’) that you give to the bank.
For secure electronic payment:
We regret that we cannot accept cheques.
* * *
CANCELLATION POLICY
For the organiser:
The organiser reserves the right to cancel the Forum owing to unforeseen circumstances. The registration fee will be refunded in full, less bank transfer charges.
For the delegate:
This registration is binding.
If you cancel before Tuesday 1 December 2009, your fee will be returned in full, less bank transfer charges, provided Dyslexia International is notified by fax or email.
If you cancel between 1 December and 22 December 2009, you will receive
50 % of your fee.
If you cancel after Tuesday 22 December 2009 we regret that the fee cannot be refunded.
A replacement delegate is welcome at no extra charge.
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