This document provides an application form for a course on EU lobbying to be held from June 4-8, 2012 in Brussels. It requests the applicant's contact information, fields of interest, and encloses required documents including a CV, cover letter, copy of ID, and proof of payment of the first installment of €400. The course fee is €850 which covers training materials, meals, a certificate of attendance, and three months of consulting. The second installment of €450 must be paid by May 25th to complete registration.

1. 4 th - 8 th June 2012
COURSE ON EU LOBBYING
Brussels
Skills and Strategies
Be lgi an - It al ia n Ch am be r o f Com me r ce
APPLICATION FORM
(Complete the application form and submit by e-mail to info@europeanlobby.eu or by fax to 0032 2 230 21 72)
Surname / family name ___________________________________________________
First name(s)______________________________________Gender:  Male  Female
Place of birth ___________________________Date of birth_______/______/_________
Address (street, square…)_________________________________________n. ______
Postal code___________City/Town__________________Country__________________
ID/Passport n. _____________________________Expiry date_____________________
Citizenship _______________________E-mail _________________________________
Telephone n.+_______/__________________ Mobile n. +_______/_________________
Company name / Job title __________________________________________________
B I L L I N G D AT A
Use previous data
Use data below:
Company name__________________________________________________________
Address (street, square…)________________________________________n. _______
Postal code ___________ City/Town ________________Country __________________
Telephone number +_____/________________Fax number +_____/________________
E-mail ________________________ VAT Number______________________________
FIELDS OF INTEREST
 Research & Development ________________________________________________
 International Business and Competitiveness__________________________________
 Public Interest Advocacy ________________________________________________
 Energy, Environment and Transports_______________________________________
 Development Cooperation and Social Issues _________________________________
 Others_______________________________________________________________

2. ENCLOSES
1. A CV in English
2. A cover/motivation letter in English
3. A copy of passport or other identification document
4. A copy of the bank receipt of the first installment of 400 euro on the following bank
account:
IBAN: BE41 6430 0009 0310 - BIC: BMPBBEBB
Bank: Monte Paschi del Belgio – Brussels
Holder: Belgian-Italian Chamber of Commerce
Reference: Course on EU Lobby – Surname and Name
___________________ _____________________
Date Signature
How have you learned about the Course on EU Lobbying ?
Newspapers/Magazines _____  Poster/Brochure  Fax
E-mail/Newsletter __________  Facebook/Twitter  Friends/Colleagues
Internet __________________  Chamber of Commerce  Other _____________
_
Only the application forms with all the enclosures sent by 11th May 2012 will be
considered. You can apply by filling in this application form and send it
 by fax at the number 0032 2 230 21 72
 by e-mail to info@europeanlobby.eu
WARNING: The enrolment will be complete after the confirmation by the Belgian-Italian Chamber of Commerce
and upon receipt of the second installment. If the application is not accepted, the first installment of
400 euro will be fully refunded.
The fee is 850 euro and includes:
 Course enrolment (May 2012 edition)
 The training material (books, documents, photocopies, CD-Rom)
 Lunches and coffee breaks
 Certificate of attendance
 Three months of free consulting on lobby activities provided by the European Desk of the Belgian-
Italian Chamber of Commerce
NOTES

th
The second installment must be paid and the receipt sent at the latest by 25 May 2012
 The invoice will be issued after payment
 In case of withdrawal by the participant, the amount paid will not be refunded
 Enclosed documents and the application form will not be given back
 Personal data are only used by the Belgian-Italian Chamber of Commerce
 The program may slightly change during the course without prior notice
 The course will run with a minimum of 10 participants