Personal information:Name* DrMrMrsMsProf Title First Last Job Title*Company/Institution*Address* Street Address City ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Phone (Int'l)*Purchase OrderAffiliated to VAT ?*YesNoVAT number*My portraitPlease attach your photo in JPG format (full face portrait; 1MB max.). The photo will be added to the participants' list to facilitate networking.Accepted file types: jpg.My CVTo help the registration committee to evaluate your application and to facilitate later the networking with your peers, you are kindly invited to upload a short CV (PDF, 10MB max.)Accepted file types: pdf.Membership:Membership Status*EFMD Full MemberEFMD Affiliated MemberNon-memberPriceEarly Bird Fee Applied (through 23 May)as EFMD Full Member Price: 3.400,00 € as EFMD Affiliated Member Price: 3.600,00 € as Non-member Price: 3.700,00 € Total price (Belgian 21% VAT included):VAT 0,00 € TOTAL 0,00 € These fees cover attendance to the meeting, documentation, meals and refreshments, but NOT hotel accommodations. EFMD has made a pre-reservation of hotel rooms. In order to book your hotel, please see the Accommodation section on the practical information page of the event.Payment method*Bank TransferCredit CardYou will find the bank details in the confirmation e-mail you will receive from the system.Credit CardAmerican ExpressMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Your credit card information is passed directly from your browser to Stripe over a secure connection.CANCELLATION POLICY: Cancellations must be confirmed in writing. If we receive notice of your withdrawal before 24 May 2019, a cancellation administrative fee of 75€ + 21% VAT will be charged. Thereafter, we regret that we are unable to refund any fees. As the Strategic Leadership Programmes for Deans is aimed exclusively at directors general/dean of the whole business schools, no substitutes will be accepted.Catering:I will join the dinners Tuesday 22 October 2019 Thursday 24 October 2019I am allergic toalmondsblueberriesboletus mushroomchivesfigshazelnutsshellfishotherif 'other', please specify:*Dietary requirementsno dairy productsno fishno glutenno meatno nutsno porkno shellfishveganvegetarianotherif 'other', please specify:*General:I agree with the terms and general conditions stated on your website.* YesI declare that all the information stated above is accurate, including allergies and dietary requirements.* YesI authorise EFMD to use all information communicated within the legal framework of its activities.* YesI agree to receive an e-mail newsletter and other communication material from EFMD.* I can unsubscribe or update my preferences at any time.YesNoTechnical informationRegistration date Date Format: DD slash MM slash YYYY Event referenceNameThis field is for validation purposes and should be left unchanged. 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