SURNAME

NAME

ADDRESS

Street

Postal Code

City

Country

phone

Mobile

Fax

email

DATE OF BIRTH

FEES

Active participant (550,00 €) possibly

Active participant, STUDENT (425,00 €)

Audience member for entire class (125,00 €)

Audience member for entire class, STUDENT (85,00 €)

Audience member for days (15,00 € / day)

Audience member, STUDENT, for days (12,00 € / day) in total: EURO

I read and I agree with the terms and conditions (> page 2) and confirm that the information given above is correct.

I will transfer the deposit of 50,00 €  (AFTER having received the confirmation of participation in the class) to the following bank account: (account details > page 2)

Bank account Romania

YES, I will pay the remaining fees no later than June 5, 2009

YES, I hereby officially register for the International Master Class for Conductors 21/6 – 04/7/2009.

DATE

CITY