EARLY BIRD RPK B form | Polymer Technology Netherlands

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Early Bird registration form

Please use this form to register for the RPK Module B.
EARLY BIRD registration is open until the 1st of August 2024. During this period, the 10% discount is applicable.

Please select:

Title

Name*

First/given name(s) prefix Family name

Phone number/Business number*

E-mail address*

Day of Birth*

Place of Birth*

Country of Birth

University / Institute / Company*

Department

Supervisor (in case PhD-student)

Business address*

Street + number City Zipcode Country

Home address (for certificate)*

Street + number City Zipcode Country

Invoice information

Invoice address

Invoice address same as above

Invoice address

Address or Post Box City ZIP / Postal Code Country

Invoice email address

PO / Budget cost number

Please contact your finance/administration department for the purchase order number or budget cost number.

PTN Sponsor*

Groups which sponsor PTN are entitled to a 10% discount on the registration fee.
Please indicate if you are member of one of the sponsor groups of PTN.

Other information

I have already succesfully participated in:

RPK-A

RPK-C

RPK-D

Please fill out your remarks or questions

Privacy*

I agree with the Privacy statement & Cancellation policy

If you don't receive a confirmation email within an hour, please contact us at rpk@ptn.nu, or try refreshing the page.

Comments

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