This document is a pre-registration form for a seminar on developing European dialogue on culture and education taking place in Brussels from June 24-28, 2013. It requests the participant's contact information and for them to select either an accommodation package organized by the Belgian-Italian Chamber of Commerce for €600 or to independently arrange their own stay in Brussels for the period of the course, with the full course fee being €700. Participants are asked to return the completed form by email before January 14, 2013.

1. PRE-REGISTRATION FORM
Course Title: DEVELOPING EUROPEAN DIALOGUE ON CULTURE AND EDUCATION
I, the undersigned
Name and Surname:
Nationality
Name of the Institution:
Role in the institution:
Address:
Post Code and City:
Country:
Telephone Number/s:
Fax Number:
e-mail:
Ask to be enrolled in the seminar organised by the Belgian-Italian Chamber of
Commerce, which will take place in Brussels from the24th to the 28thJune 2013.
I accept that the course fee is: € 700
( ) I will make use of the accommodation and subsistence package organized by
the Belgian-Italian Chamber of Commerce (hotel, breakfast, lunch):€ 600
Check-in the 23thJune – check-out the 28thJune 2013
or
( ) I will take care independently of my stay in Brussels for the period of the
course.
Date _________________ Signature ________________________________
To be sent back via email to gaioni@ccitabel.com before January 14th2013.