Registration

 


Note: it is obligatory to complete the spaces marked by *
 

Customer number, as far as known:

  

Title (e.g. Dr.):

  

First name: *

  

Addition to last name (e. g. van):

  

Last name: *

  

Company 1:

  

Company 2:

  

Street and house number: *

  

City code: *

  

City: *

  

Country: *

  

Phone:

  

Fax:

  

E-Mail:

  

DFAV Membership number:

  

Date of Birth (DD-MM-YYYY):

  - -

Notes:

  
 

Hereby I bindingly enroll person(s) to the FIBO-Convention from 27 - 30 April 2006 in Essen.

Thursday Friday Saturday Sunday

Indoor Cycling only:


I transferred the fee amounting to  each participant to the account no. 8013561010 (Pure Emotion GmbH) with the Volksbank Niederrhein eG, Moers (Code 354 611 06) or I released a standing order for a direct debit.

 

I pay by: 

Name of account holder:

 

Account number:

  

Bank code:

  

Bank:

  

Should you wish to make use of our "5+1"-offer and you like separate invoices, then please list the additional addresses here:

  

By transmitting this form I acknowledge the conditions of the convention.

      

Conditions:
In case of written cancellation 14 days before the convention at the latest, a 25% fee is to be paid. After that period, a cancellation is no longer possible, however, you can name a substitute. Participation at one's own risk. We recommend a health check at your physician. In case the convention should not take place due to force majeur, the organizer cannot be held liable for compensation in any case. However, an alternative date will be offered.