| Yes, I want to invite guests at my table(s) at the Gala Award Event on December 8th 2011 at ICC Ghent |
| * Please book for me the following number of tables for 8 persons: : |
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| * Name: | |
| * First name: | |
| * Function: | |
| * Company: | |
| * Address: | |
| * NR: | |
| PO box: | |
| * POSTAL CODE: | |
| * Stad: | |
| * Phone: | |
| Fax: | |
| * Your email address: | |
| Member of: |
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| Invoice name: | |
| Invoice first name: | |
| Invoice function: | |
| Invoice company: | |
| Invoice address: | |
| INVOICE NR: | |
| Invoice PO box: | |
| INVOICE POSTAL CODE: | |
| Invoice town: | |
| Order nr.: | |
| INVOICE VAT: | |
| Contacted by: |
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