REGISTRATION

(ONE REGISTRATION FORM PER PARTICIPANT)

“INNOVATION & COOPERATION: A KEY POLICY FOR

CO-OPERATIVE GROWTH & CREATION”
MOSCOW, 19-21 APRIL 2010
Please use block capitals or type and return it now
COOPERATIVES EUROPE asbl ◊ avenue Milcamps 105 ◊ BE - 1030 Brussels
office@coopseurope.coop
28/06/

I. PARTICIPANT
FAMILY NAME, FIRST NAME

II. ADDRESS
ORGANISATION

ADDRESS

POSTAL CODE CITY COUNTRY

TEL. FAX E-MAIL

III. REGISTRATION FEE

UNTIL 26TH FEBRUARY 2010 AFTER 26TH FEBRUARY 2010 ON-THE-SPOT

550 € 700 € 750 €

The registration fee includes working papers, coffee breaks and 2 lunches. There will be 10% off by group of 11 people
(written request needed).

I will participate in the following workshops (tick workshop of your choice):

APRIL, 20TH 2010 APRIL, 21ST 2010

[ ]A 1– NEW CO-OPERATIVE SECTOR [ ] A3 – CO-OPERATIVE IMAGE BUILDING &

DEVELOPMENTS BRANDING

[ ]A 2– CO-OPERATIVE GROWTH MODELS [ ] A4 – 2012: INTERNATIONAL YEAR

OF CO-OPERATIVES
IV. METHOD OF PAYMENT (CHEQUES ARE NOT ACCEPTED)
□ BY BANK TRANSFER* (on receipt of the invoice and only before April, 6th 2010).
□ BY CREDIT CARD*
□ AMERICAN EXPRESS □ DINERS CLUB □ MASTERCARD □ VISA

□ PERSONAL CREDIT CARD □ PROFESSIONAL CREDI CARD

NUMBER:

NAME OF THE OWNER (ORGANISATION OR PERSON):

NAME OF THE USER (PROFESSIONAL CREDIT CARD):

EXPIRY DATE: TOTAL AMOUNT IN €:

DATE & SIGNATURE

*The bank charges will be borne by the participants.

V. INVOICE ADDRESS, IF DIFFERENT TO THE ABOVE-MENTIONED ADDRESS

VI. OTHER (PLEASE SPECIFY)

Special diet:

Services needed for disabled persons:

Other requests:

VII. REGISTRATION CONFIRMATION

Registration confirmation will be sent to you via e-mail within 3 weeks upon receiving full payment.

VIII. HOTEL INFORMATION

CENTROSOJUZ has secured accommodation at reduced rates for the participants of the Regional Assembly
and the European Co-operative Convention. A hotel booking form will be posted on the COOPERATIVES
EUROPE’s website in early January 2010.

IX. PLEASE NOTE:

1. Registrations will only be valid once the payment has been completed or on the basis of attached
proof of payment.
2. The secretariat advises you to send your registration as soon as possible for your needs and
choices to be met.
3. Cancellations will not be reimbursed but substitutions will be accepted.

DATE & SIGNATURE