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Complete the
online registration form, minus credit card information,
and print out a copy of your form before submitting registration
information. Fax, mail or e-mail a copy of your completed
registration form, along with payment, to the “Sixth International
Eosinophil Symposium” at the Institute for Medical Immunology, as
follows:
Payment by credit card:
add credit
card information to completed form and fax to:
Institute for Medical Immunology
c/o
Christelle de Beys (Sixth International Eosinophil Symposium)
Rue
A. Bolland, 8
6041 Gosselies
Belgium
Fax : (0032) 71/ 378.563
cdebeys@ulb.ac.be
Payment by check:
Check must be made payable to the “Sixth international eosinophil
symposium”
mail
check, with copy of completed form, to:
Institute for Medical Immunology
c/o
Christelle de Beys (Sixth International Eosinophil Symposium)
Rue A. Bolland, 8
6041 Gosselies
Belgium
Payment by bank transfer:
E-mail/fax copy of completed form and the proof of transfer, to:
Institute for Medical Immunology
c/o
Christelle de Beys (Sixth International Eosinophil Symposium)
Rue
A. Bolland, 8
6041 Gosselies
Belgium
Fax : (0032) 71/ 378.563
cdebeys@ulb.ac.be
Information
for the bank transfer:
Bank name:
DEXIA BANQUE SA
Account name:
“Sixth international eosinophil symposium”
Account number:
068-2502004-13
IBAN:
BE08-0682-5020-0413
SWIFT:
GKCCBEBB
Bank Address:
44, Bd. Pacheco 1000 Brussels, Belgium
!! Please ensure that the name of the congress (“Registration
6IES”) and of the participant are stated on the bank
transfer.
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