PolyReg: Registration form for training courses 2012

(Form to be printed; please mark your selected course)
 Initial Training (Fr. 650.--)
   IT-12-01 (Geneva / F, 03.05.2012)
   IT-12-02 (Zurich / G, 31.05.2012)
   IT-12-03 (Zurich / G, 07.06.2012)
   IT-12-04 (Lugano / I, 15.06.2012)
   IT-12-05 (Zurich / G, 21.08.2012)
   IT-12-06 (Zurich / G, 13.09.2012)
   IT-12-07 (Zurich / E, 25.10.2012)
   IT-12-08 (Zurich / G, 13.11.2012)
   IT-12-09 (Lausanne / F, 22.11.2012)
   IT-12-10 (Zurich / G, 13.12.2012)
 Recurrent Training (Fr. 340.--)
   RT-12-01 (Geneva / F, 04.05.2012)
   RT-12-02 (Zurich / G, 08.05.2012)
   RT-12-03 (Zurich / G, 24.05.2012)
   RT-12-04 (Zurich / G, 05.06.2012)
   RT-12-05 (St. Gallen / G, (05.07.2012)
 Recurrent Training (continued):
   RT-12-06 (Zurich / E, 14.08.2012)
   RT-12-07 (Zurich / G, 28.08.2012)
   RT-12-08 (Zurich / G, 06.09.2012)
   RT-12-09 (Lugano / I, 14.09.2012)
   RT-12-10 (Bern / G, 18.09.2012)
   RT-12-11 (Olten / G, 25.09.2012)
   RT-12-12 (Zurich / G, 04.10.2012)
   RT-12-13 (Zurich / G, 12.10.2012)
   RT-12-14 (Zurich / G, 16.10.2012)
   RT-12-15 (Zurich / G, 08.11.2012)
   RT-12-16 (Zurich / G, (20.11.2012)
   RT-12-17 (Lausanne / F, 23.11.2012)
   RT-12-18 (Zurich / E, 27.11.2012)
   RT-12-19 (Zurich / G, 04.12.2012)
   RT-12-20 (Zurich / G, 18.12.2012)
   (Reserve)

Member:
(other Members you represent:)
Name / First name:
Title / Function:
Address: Zipcode/Place:
Phone: E-Mail:
Date: Signature:

If you assume functions for more than one member of PolyReg please indicate those firms. The first member mentioned will be invoiced.

Send to: PolyReg General Self-Regulatory Organisation, Training administration, Florastrasse 44, 8008 Zürich
or fax to: 043 / 499 80 56.
Registrations sent by e-mail can not be accepted.

This registration is binding. The following charges will be made for no-shows or cancellations:

- up to 4 days before the course:  30% of the costs.
- 3 days or less before the course:  60% of the costs.