BluePoint Brussels – Bd Auguste Reyers 80 – 1030 Brussels
+32 2 706 82 80 - [email protected] - www.ecgassociation.eu
ECG Academy
Certificate in Automobile Logistics Management
REGISTRATION FORM
I apply to register for the ECG Academy Course of 20/20
Please fill in the form in capital letters, as legibly as possible.
Participant
☐ M
☐ F
Last name ....................................................................... First name ..................................................................................
Company ...............................................................................................................................................................................
Position ........................................................................... GSM ...........................................................................................
E-mail .....................................................................................................................................................................................
Special dietary requirements (if any) ................................................................................................................................
Business address
Invoicing address (if different from business address)
Company name ............................................................... Company name ..........................................................................
Street / P.O. Box.............................................................. Street / P.O. Box ........................................................................
Postcode .......................................................................... Postcode ....................................................................................
Town ................................................................................ Town ..........................................................................................
Country ............................................................................ Country .......................................................................................
VAT number for invoicing .......................................................................................................................................................
Other contact person (if relevant, e.g. HR).
Name ......................................................................................................................................................................................
Position ...................................................................................................................................................................................
Telephone ...............................................................................................................................................................................
E-mail .....................................................................................................................................................................................
Your checklist - what you need to send us by e-mail
☐ This registration form, duly signed (PDF format)
☐ An up-to-date Curriculum Vitae (PDF format)
☐ A portrait photo of you in jpg format
☐ I will ensure the fee invoice is settled in full before the start of the Course
Place ................................................................................ Date ............................................................................................
Signature ..........................................................
Please scan and email the completed form to [email protected]
