Registration form Calendar page Pump Engineer

Please print the completed form and mail to:
Pump Engineer
PO Box 396
7200 AJ Zutphen
The Netherlands
tel: +31 575 585 270
or
fax to +31 575 511 099

	YES, please register me with basic information on our event. This includes Name Event, Date, City and Country. FREE OF CHARGE. (only relevant events will be considered)
	YES, please register me with full details on our event. This includes Name Event, Date, City and Country, Phone, fax, email address , web link, logo banner. The cost for this registration is Euro 800 for a period of six months.

Event information

Free of charge
Name Event
Begindate Event (dd/mm/yyyy)
Enddate Event (dd/mm/yyyy)
City
Country
Paid information
Phone
Fax
Email
Weblink
Logo banner
Publication period	6 months 12 months 18 months 24 months

Submitted by

Mr./Mrs.:
Function:
Company:
Address:
City:
Zip code:
Country:
Phone:
Fax:
E-mail:

Payment Information

Charge my credit card Visa American Express Euro/Mastercard for Euro
Card number
Expiry date
CVC*
Cardholder's name
Cardholder's signature :

If you wish to pay by bank transfer, please contact Mr Tom Bleumink at phone# +31 575 585 274.

*In addition to the credit card number, a card verification code (CVC) is required. This is new, and has been introduced to provide more security for both the customer and the mail order company. We will not be able to process credit card transactions without a verification code.
For Visa and Mastercard/Eurocard you can find your CVC on the reverse side of your credit card, printed into the signature filed. It is a three-digit number. The full credit card number is reprinted in the signature box and at the end of the number is the verification code number:
For American Express the verification code number is a four-digit number on the front of the card above the credit card number on either the right or the left side of your American Express credit card.

Pump Engineer cannot guarantee the accurancy of information provided by participating event organisers . The publisher reserves the right to decline and /or modify events without prior notice.

Please return per fax:
KCI Publishing BV, attn Ms Simone Vermoolen, PO Box 396, NL-7200 AJ Zutphen, the Netherlands
Tel : +31 575 585 279fax: +31 575 511 099

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