APPLICATION

Wednesday, December 3rd, 2014, at the Hotel InterContinental, Berlin
Please note: Due to space restrictions, participants need to be accepted for this event.
Please fill in the form below. Items marked with * are required.
Title (e.g. Dr, Prof, etc.):
Form of address:*
Surname:*
First Name(s):*
Company / Institution:*
Job Title / Position:
Street or P.O. Box:*
Zip / Postal Code:*
City:*
Country:*
Telephone with area code:*
Fax with area code:
E-Mail:*
Homepage:

REGISTRATION

I am a teacher / teacher trainee and want to
      register for the School Forum 2014 free of charge
I want to register for the School Forum 2014 for 59.50€ (incl. 19% VAT)

PAYMENT

Please indicate your preferred method of payment:
Please send me an invoice
Please debit my credit card
Type of card:




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CCV Number: