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February 2009

Registration Form

Bsik Smart Surroundings Event

Wednesday 4 March 2009

The Hague

(one form per person please)

 

 

 

 

 

 

Name

:

 

 

 

Initials

: Mr./Ms.*

 

 

 

Organisation

:

 

 

 

E-mail

:

 

 

 

Telephone

:

 

 

 

 

 

 

[ ]

I’d like to visit the knowledge fair *

 

[ ]

I’d like to join for lunch *

 

[ ]

I’d like to reserve a car park space *

 

 

 

[ ]

Unfortunately I will not participate *

*)

(Please tick what is applicable)

 

 

 

 

 

 

 

 

 

 

 

 

Please return this registration form before 26 February 2009

to SenterNovem Bsik, attn. Kamla v.d. Lelie,

P.O. Box 93144 - 2509 AC The Hague – The Netherlands

by fax: +31 70 373 5100

by e-mail: bsik@senternovem.nl

Please direct any questions regarding logistics to Anneke van Staden

Tel.: +31 70 373 56 62