European English Aglow
Email address *
First name *
Please enter your first name
Your answer
Last name *
Please enter your last name
Your answer
Email address *
Please enter your email address
Your answer
Phone number *
Please enter your phone number
Your answer
Address *
Please enter your full address including postcode
Your answer
Chapter *
Which chapter do you attend?
Newsletter *
Would you be interested in receiving the European English Aglow newsletter?
About your stay at the Conference
Arrangements A-C include accommodation (with bed linen and towels), breakfast, lunch, dinner, tea & coffee, and conference fee:

A: Single occupancy, with ensuite, € 245
B: 2 person occupancy, with ensuite € 230
C: 3-4 person occupancy € 215
D: Saturday day guest (08.45—22.00 hrs) € 140 p.p. (Day Guest price does not include breakfast)

Free wifi available in the conference centre.
Arrangement choice *
For arrangements B-C, please indicate who you would like to share a room with. Please note that we cannot guarantee your roommate request.
Your answer
Special Needs
Limited availability - allocated on a first come first served basis.
Dietary request
Please indicate your special dietary request (there are 4 options)
Agreement and payment
I understand that:

. on submission of this form an automatic email will be generated which includes the details I typed in for my review

. my registration is only complete once payment is received and that confirmation will be sent to me on receipt of payment

. in the event that I cancel my registration, the €15 fee will be deducted from my refund. If I do not cancel before 28 February 2020 I will be obliged to pay for the Conference place reserved for me should I not attend

. the president of my local chapter will be informed of my registration
Agreement *
Payment *
Please indicate how you wish to pay
Payment by Bank or Paypal only ('Pay on arrival' is no longer available).

If you experience a problem with the bank transfer then please contact the Administrator.

Bank transfer details:

Stichting European English Aglow
Beethovenlaan 44
2264 VG Leidschendam
The Netherlands

IBAN: NL20INGB0007299395
Conference place confirmation
Confirmation will be sent once your payment has been received.
Paying with PayPal?
After you submit this form, you will be able to click a link to take you to the beginning of the PayPal process.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Protempo Limited. Report Abuse