Microfinance with a Mission: Learning Together
 
 
 
 

REGISTRATION FORM
Please complete no later than 25 April 2006
One registration form per participant

 
First Name:
Family Name:
Mr.      Ms.  
Job Title:
Organization Name:
Practitioner Donor Investor Consultant Other

Organization Address

Street :
Town :
Country :
Zip code:
Tel.(with country & local code):
Fax (with country & local code):
E-mail (personal):
E-mail (organization):
Web page:

REGISTRATION FEE
(three day conference - per one person)
Please select currency of your payment

MFC and EMN members
US $ 370 or EUR 290
     		MFC and EMN non-members
US $ 500 or EUR 390
    

SPECIAL DISCOUNT FOR MFC and EMN MEMBERS ONLY
If there is more than two people from the same organization in the same country-
the rate for the third person and more is:

MFC and EMN members
US $ 320 or EUR 250
    

The fee includes lunch on Thursday, Friday (8-9 June) and additional evening event on Thursday (8 June). Participants are responsible for their visas, if applicable, travel and accommodation arrangements, and health/accident insurance.
The payment deadline is 30 April 2006

PAYMENTS:

Please transfer the payment before 30 April 2006 to:

Beneficiary (account) name: MFC Sp. z o.o.,
[PLEASE DO NOT STATE "MICROFINANCE CENTRE"!]
   
Beneficiary address: ul. Koszykowa 60/62 m.52, 00-673 Warsaw, Poland
Bank: FORTIS BANK POLSKA S.A. First Warsaw Branch, Poland
SWIFT code: PPABPLPK
Account: PL74160010680003010200570023 (for payments in USD)

Intermediary bank
(if necessary) 		Bank of New York, SWIFT: IRVTUS3N;
Account Number: 890-0060-697
   
Account: PL04160010680003010200570022 (for payments in EUR)
Intermediary bank
(if necessary) 		FORTIS Bank N.V., Brussels, Belgium, SWIFT: GEBABEBB36A;
Account Number: 291-1123182-19-EUR-0
   

As a title of payment please specify: “MFC-EMN Conference" and participant's name. Please cover all extra bank charges, so that MFC receives the whole amount of the participation fee.

There will be full refund for cancellations received before 7 May.
There will 90% refund for cancellations received between 7-26 May.
There will be no refund for cancellations received after 26 May.

Any refunds will be made at participant’s costs.