DEADLINE: May 20th, 2004
Mrs/Miss/Mr
________________________________________________________________________________________
Name Family
Name
__________________________________________________________________________________________________
Institution
__________________________________________________________________________________________________
Mailing address of the institution Postal code - City Country
__________________________________________________________________________________________________
Telephone Fax E-mail
I
wish to attend the training session No. ________
Payment order
¡
¡
Account
No.: 02053-0012745211
Account No.: 02053-0012745211
IBAN:
SI56020530012745211
Notification: 00 117-04
Swift
Code: LJ BASI2X
Bank
Name: NOVA LB d.d.
Bank Name: NOVA LB d.d.
Notification:
ZTM 2004
I
am authorising Kongres d.o.o. to charge
my credit card for the amount covering my
registration
fee: Visa □
Eurocard/Mastercard
□
Credit
Card No. ________________________
Controll
No._____________________
Expiry
date____________Credit Card Holder _____________________________________
(as
written on the card)
___________________
_________________________________
Date
Signature
TO BE SENT BY MAIL TO THE FOLLOWING ADDRESS:
KONGRES d.o.o., Dolomitskega odreda 44 |