On the 25th of March 2017
	we celebrate the 70th anniversary of the
	"Koninklijk Gallois Genootschap"
	at the festive hall "HORTA"
Hopland 2
B-2000 Antwerpen
Start: 19h00 Finish - 02h00
Dress code: business casual
Inscription and payment to be done before February 25th. 2017

Name*		First name
Street*		N°
City*		Postcode
E-mail*
	Member(s) & partner(s)	Number	x € 65
	Non-members	Number	x € 90
		Total	€
Payments will be done on the account of the Koninklijk Gallois Genootschap  IBAN BE36 9799 8300 5681 SWIFT : ARSPBE22  before February 29th of 2012