Registration Form for the conference of ENTMA, the European Network of Trainers in the Management of Aggression.

Please, send (or fax to ++ 31 (0)20 409 0550) your completed registration form and indication of payment to:
Oud Consultancy & Conference Management, Hakfort 621, 1102 LA Amsterdam, the Netherlands.

Conference fees
Please tick the appropriate box.

	Before 1-10-2008		Before 1-10-2008		After 30-9-2008		After 30-9-2008
	Bank transfer		Creditcard		Bank transfer		Creditcard
Conference fees	€ 399,-		€ 419,-		€ 449,-		€ 471,-

I declare that I have read the general information and registration and payment conditions and I agree with the release and waiver of liability policies, the disclaimer, as well as the policies regarding cancellations and registration refunds.

In consideration of my participation in the first 2008 conference of ENTMA, the European Network of Trainers in the Management of Aggression, I do hereby release, discharge and hold harmless Oud Consultancy and cosponsors, from any and all liability by reason of any damage, loss, expense, or injury arising from my participation in this event, including that caused solely or in part by the fault (including but not limited to negligence, gross negligence, and recklessness) of the above-named parties. This release and Waiver of Liability shall be binding on my heirs, executors, administrators, successors, and assigns.

	Mr     Ms
First Name:
Family Name:
Street:
Post ZIP Code:
City:
Country:
Tel.:
Fax:
E-mail:

Payment (no cheque)

Please select payment method:         Bank* Credit card
*I have deposited my payment (free of charges for the recipient) in bank account number 68.13.06.157 of the ING Bank, Amsterdam, The Netherlands, in the Name of Oud Consultancy, Hakfort 621, 1102 LA Amsterdam and have mentioned my Name for ENTMA 2008. For international payments use our (IBAN) International Bank Account Number: NL56 INGB 0681 3061 57, and (BIC) Bank Identity Code: INGBNL2A.
I authorise Oud Consultancy & Conference Management to debit my credit card for € ,-.
Please select credit card:                   Visa Card Master Card American Express		Signature:
Name Card Holder:
Card Number Visa / Master / Amex:
Expiry date:
Card Verification Code (CVC):
Date (date/month/year):

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