Registration Form

IHRE DATEN / YOUR DATA * information is necessary Lastname *  Firstname *  Gender   männlich / male weiblich / female Institution / Company *  Straße / Address *  PLZ Stadt / City, ZIP Code *  Land / Country *  Billing address, if different   VAT-Number   VAT-No is necessary for all participants from EU-COUNTRIES! (not Germany) Phone   Fax   E-Mail *  Please read and accept *  general terms and conditions Bitte geben Sie die Zahl aus der Grafik ein / Please type the number of the graphic *    INFORMATION BEZAHLUNG / PAYMENT Bitte auswählen / Please choose   DIK and DKG member (650,-- EUR) Non member (800,-- EUR) Active participant (390,-- EUR) Student* (300,-- EUR) *Students have to send a letter verifying their status (fax or postal mail). Geplante Form der Bezahlung / Planned type of Payment   Kreditkarte / Credit card Banktransfer (attendance at KHK 2012 is only possible after payment) ANDERES, FRAGEN / OTHERS, REQUESTS... Teilnahme / Attendence at Conference dinner    (price for attending the conference dinner for 1 person is included) Vegetarier / Vegetarian   Comments (add. questions)

Please recognize that - in case of your deregistration - the refund of your fee depends on the date of your deregistration.

If you have any further questions concerning the Rubber Fall Colloquium 2012, please don't hesitate to contact us via our request form.