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General Assembly Delegate Form

About You

Which organization do you represent? *

If you are an Honorary Member, voting delegate for a Global Partner, or Professional Member, please select the appropriate entry. If you are sure your organization is a (voting) member but can't find it, please select 'NOT LISTED'.

Your Name *

Birthdate *

Gender *

Nationality *

Passport Number *

Expiry Date *

How Can We Reach You?

Your Email Address *

Your Phone *

Please include the country code.

Cell Phone

Address *

For invoicing purposes

Voting and Accommodation

Do you have a voting mandate? *

Yes, I will vote on behalf of my Federation or Club. No, I will attend but cannot vote.

Will you physically attend the meeting? *

Yes I will attend in person No, I will attend the GA on-line.

Date of arrival *

Date of departure *

Are you staying at the Brussels, Belgium? *

Yes I will stay at the Brussels, Belgium No I will be using other accommodation

Will you be accompanied by someone?

A friend, wife, husband, or otherwise who will not attend the GA.

Companion Program

You can bring multiple persons (spouse, kids, etc.).

No, I will come by myself. Yes, I will bring someone that will NOT attend the GA.

Companion Name *

Please provide the name and email address of the main person here.

Prefix

First *

Last *

Birthdate *

Gender *

Nationality *

Passport Number *

Expiry Date *

Companion Email Address *

Companion Phone *

Do you wish to attend the exclusive dinner in the Sky at the top of the Atomium on Thursday 12 November? (cost 90 euro per person) Yes, I wish to attend.

How many people? *

Do you wish to attend the dinner in the Town Hall (Grand Place) on Friday 13 November? (cost 110 euro per person) Yes, I wish to attend.

How many people? *

Do you wish to attend the Gala Dinner at Autoworld on Saturday 14 November? (free of charge, offered by BEHVA) Yes, I wish to attend.

How many people? *

*These activities will be invoiced to you directly by BEHVA. The reservation will be confirmed only after the payment.

What else is on your mind?

Please let us know what's on your mind. Have a question for us? Ask away.

Your Comments/Questions

I acknowledge that by submitting this form it will automatically be copied to the relevant FIVA member *

General Assembly Delegate Form

About You

How Can We Reach You?

Voting and Accommodation

Will you be accompanied by someone?

What else is on your mind?

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