Registration Form

To register, please fill in this form. All fields marked with an asterix (*) are mandatory fields.

Information on the participant
Congress fee (*) € 130,-- per person for early bookers until 30 April 2012! € 160,-- per person after expiry of the early bird bonus from 01 May 2012 onwards. € 80,-- per person for students. Others: (please fill in the field below) Pflichtfeld Other participation Invalid Input
Company Invalid Input	Title Ungültige Eingabe
First name (*) Pflichtfeld	Last name (*) Pflichtfeld
Phone (*) Pflichtfeld	Fax Invalid Input
Postal code (*) Pflichtfeld	City (*) Pflichtfeld
Address (*) Pflichtfeld	Country (*) Pflichtfeld
Email address (*) Pflichtfeld	I will arrive by train (*) Yes, I will arrive by train Invalid Input
Remarks Anmerkungen bitte hier eintragen
Invoice address If different from the address above
Company name Invalid Input	Invoice name Invalid Input
Postal code Invalid Input	City Invalid Input
Address Invalid Input	Country Invalid Input
Side events
Participation in the evening reception on 19 June 2012 Yes, I will participate Invalid Input
Participation in the evening reception on 20 June 2012 Yes, I will participate and I will be accompanied by another person (costs € 40.--) Invalid Input
Participation in the field trip, 19 June 2012 Yes , I will participate in the field trip Invalid Input
Participation in the field trip, 21 June 2012 Yes, I will participate Invalid Input
I accept the General Terms and Conditions (AGB) of the Fine Dust Congress 2012 Pflichtfeld