BILBAO MONDRAGON 2002

21-22-23 NOVEMBER 2002

FOURTH EUROPEAN MEETING OF EMPLOYEE OWNERSHIP

REGISTRATION FORM (one form by participant please)

Please return to:

EFES, Avenue Voltaire 135, B-1030 Brussels

Fax: +32 (0)2 242 64 30

E-mail: marc.mathieu@ping.be

1. Participant (fill in block capital letters)

Mr/Mrs/Ms

First name

Last name

Position

Company / Organization

Address

Zip Code City

Country

Fax

Phone

E-mail

2. Participation dates (tick your choices)

I shall attend on these dates :

O Thursday 21 November. Meeting and workshops in Bilbao

O Thursday 21 November. Evening to Guggenheim Museum

O Friday 22 November. Visit to Mondragon

O Saturday 23 November, matin. Workshops in Bilbao

O Saturday 23 November, afternoon. Internal meetings of EFES

3. Workshops participation

I would like to take part in the following workshops on 21 November (you can tick several choices):

O Workshop 1: The SAL model

O Workshop 2: Federations and business centers

O Workshop 3: Evidences of enterprises

I would like to take part in the following workshops on 23 November (you can tick several choices):

O Workshop 1: Mobilizing latecomers countries

O Workshop 2: European training programmes

O Workshop 3: New priorities for EFES

O Workshop 4: Theme to decide ; I suggest the following theme : …..

4. Contribution towards costs

I pay my contribution of :

O 295 EURO for non-EFES members

O 250 EURO for EFES members

5. EFES membership

I wish to become a member of EFES and I pay my membership fee, covering years 2002 and 2003 :

O as an individual, 50 Euro

O as a company or organization, 500 Euro

6. Payment

O by bank transfer to account number 879-3657201-78 of EFES to Delta Lloyd Bank in Brussels, Belgium (swift key BNAGBE BB) mentioning : « Meeting + your name » ;

O by cheque addressed to EFES, Avenue Voltaire 135, B-1030 Brussels

O please, send me a justifying invoice

Date and signature:

....................... (date) .................................................(signature)