INCREASE YOUR
IMPACT AND INFLUENCE

Reading statements from former participants of the course might help!
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Please fill out the form for registration.

	Mr Ms Mrs
First name*:
Last name*:
Email address*:
Mobile phone number*:
Direct phone number:
Fax number:
Job title:
Company*:
Street*:
Postal code*:
Town*:
Country*:
Invoice address (if different):
Name / company:
Street:
Postal code:
Town:
Country:
Other details which need to appear on the Invoice:
Please register these colleagues as well:
First name Last name Email address 1. Person 2. Person 3. Person 4. Person 5. Person
Please recommend us others who would benefit to attend this course as well:
First name Last name Email address 1. Person 2. Person 3. Person
More general information:
Further remarks:
	I do not require accommodation at the Grand Hyatt hotel during the course
	* I confirm my registration and accept the terms and conditions. An administration fee of EUR 150 will be charged if I cancel my registration before Monday, February 15, 2010. If I change my registration or cancel on Monday, February 15, 2010 or after, the full registration fee remains due, unless I register another colleague in my place.
	* required fields