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INNOVATOR PRIZE 2012 - Brussels
1. Name : First name :
Title :
Alumni Association
Company :
Belgium
Address :
E-mail :
Phone : Fax :
Accompanied by :
Title : Company :
will be present at the 2012 INSEAD Innovator Participation fee :
Prize Conference and Gala Dinner € 125 per person / or if paid by company
at The Plaza € 100 per IAA paid-up member
on Friday, November 16, 2012 € 75 for IAA paid-up member promotions 2010/2011/2012
Please transfer the amount to IAA Innovator Prize account :
IBAN BE48 0016 3462 7327 - BIC GEBABEBB
RSVP :
An invoice will be sent upon receipt of payment.
INSEAD Alumni Association of Belgium asbl/vzw
Oudergemseweg, 40
Cancellations and refunds will not be accepted after Thursday, November 8, 2012.
B-1970 Wezembeek-Oppem
e-mail : info@inseadalumni.be
As the number of guests is limited, receipt of payment will determine priority of acceptance.
Fax : 02 / 768.28.94