Haute Ecole

EPHEC
Louvain-la-Neuve
Brussels
Ecole Pratique des Hautes Etudes Commerciales Think different
create together

International Marketing Week

Packaging and sustainable development

Belgium 29 March 2009 - 3 April 2009

Student Application Form

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Marketing Week - Haute Ecole EPHEC

Packaging and sustainable development
29 March 2009 – 3 April 2009
Contract with the student – Registration Form
Personal Information
Name …………………………………….………………………
First Name …………………………………….………………………
Nationality …………………………………………………………….
ID – card number …………………………………………………………….
Address …………………………………………………………….
…………………………………………………………….
…………………………………………………………….
Country …………………………………………………………….
Date of birth ……………………………….. Male - Female
Place of birth …………………………………………………………….
Telephone number(s) …………………………………………………………….
E-mail …………………………………………………………….

Home School / University Information

Name School / University …………………………………………………………….
Address ……………………………………………………………..
……………………………………………………………..
……………………………………………………………..
Field and option of study ……………………………………………………………...
Study year (semester) ……………………………………………………………...

Person in charge in your home institution

Contact person : Name : ………………………………………………………….

: ……………………….………………………………………
Email : ……………………..…………………………………….

Position : …………………………………………………..

Accommodation
I need /  do not need accommodation for 5 nights (29/03 to 03/04)

Contact person in emergency case : Name : ………………………………………….

: ………………………………………………
Medical or other problems: …………………………………………………..
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The undersigned participates in the entire programme and pays 150€

(including programme, accommodation, social activities, local transport).
He/she commits him/herself to participate in all the activities of the International
Marketing Week 2009 and to pay the personal costs involved.

He/she is expected to behave correctly during the International Week, both in the
university buildings, as well as during the various activities.

The registration can only be guaranteed after payment of the registration fee.

Date : ………………… Name : …………………………..…………………………

Signature : ………………………..

Please send or fax this completed form

by 2nd February 2009
to Mrs Barbara BROOIJMANS at the following address :

Haute Ecole EPHEC

Marketing Department
Avenue du Ciseau 15
B – 1348 Louvain-la-Neuve
Tel. +32 10 47 53 90
Fax +32 10 47 53 91
Internationalweek@ephec.be

Registration Fee

Pay 150,00 € to the following account before 2nd February 2009

Account name : EPHEC ASBL

IBAN : BE37 2100 8966 4428
BIC : GEBABEBB
Bank Name : FORTIS BANQUE
Please mention your name and institute as well as “International Week 2009”.