Conference Registration Form

MED PORTS 2002

Tuesday, April 23^rd 2002

To register for the conference, please complete this form in PRINTED CAPITALS and return it to

MARE FORUM by Fax at +31.10.205.5655

Only one delegate should register with this form. Extra copies can be obtained from the conference office, or copies of this form may be used. Registration deadline is set for April 13^th 2002.

FIRST NAME(S):	M/F
NAME:
ORGANISATION:
JOB TITLE:
MAILING ADDRESS:
POSTAL CODE:
CITY:
COUNTRY:
TELEPHONE:
TELEFAX:
E-MAIL:

Conference Fee

Person-restricted Pass: EURO 500 ,- + EURO 95,- (19% VAT) Total Amount Due: EURO 595,-

The conference fee includes conference attendance and documentation, refreshments, luncheon during scheduled breaks in the conference programme, reception and dinner.

Conditions (Please read carefully):

Please note that a Person – Restricted pass means that only the registered participant will be admitted for any of the activities of the conference. A Person Restricted Pass may not be shared by more than one person. Please note that all payments must be made in EURO’s and free of all bank or other charges.

Should you be unable to attend the conference, a substitute participant is always welcome at no extra charge if he / she carries a letter of authorisation from the original participant and if the conference office has been notified of the name of the substitute participant before conference date.

Cancellations & Refunds:

Refunds will be dealt with after the conference.

Mare Forum reserves the right to charge a handling fee of EURO 100,- for cancellations made before April13^th 2002.

If cancellation is made after April 13^th 2002 no refunds will be made, full payment is required.

Conference participants are also invited to attend the conference reception & dinner:

 I will be attending the Conference Reception & Dinner on April 23^rd 2002.

Payment Method

Bank Wire Transfer: The total amount due for participation in the MED PORTS 2002 conference has been transferred by bank wire transfer to ING Bank account number 65.21.54.646 Rotterdam, The Netherlands.

Accountholder: Mare Forum B.V. Swift Code: INGBNL2A

Note: Please be sure that your payment is accompanied by your full name and the reference code

"Med Ports 2001".

DATE:

SIGNATURE

PLEASE SEND THIS FORM BY FAX TO:

FAX: +31.10.205.5655

MARE FORUM , World Trade Center, P.O. Box 30027, 3001 DA Rotterdam, The Netherlands

Tel: +31.10.205.7455, e-mail: info@mareforum.com