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printable form: Word file / PDF file

* First Name
* Last Name
* Email Address
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* Company Name
Internet Website
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* Address 1
Address 2
* City
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* Zip/Postal code
* Country
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Please choose a single option from the following (A,B,C):

				Euros
A-	Full Package (4 days)	500 Euros	=
B-	Daily Package	150 Euros	=
	Choose date: 12 13 14 15
C-	Market & Exhibition ONLY (4 days) [included in the daily/full packages!]	50 Euros	=
	- discount
	* Total Euros

Full & Daily Package registrations (A & B) include free admission to:

Programme Market & Videokiosk
Technical Exhibition
All Conferences, Workshops and Forums
Social Events (excluding food and beverages)

Payment information

Submissions with no payement information won't be registered!

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* Expiry Date (mm/yy)
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Notes, remarks

CANCELLATION POLICY:
No refund is made unless a cancellation is received, in writing,
NO LATER THAN JUNE 5, 2002
Fax Switzerland +41 21 925 80 35, Fax USA+1 760 280 6390, email:info@mitil.org

You may also print & fax this page at
+41 21 925 80 35
or dowload the printable form: Word file / PDF file

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