Registration form - Innovation Management

| CHOICE OF MODULES |

By default, I register for all the modules. If not, in addition to the mandatory Module 1, I register for the following modules *

| IDENTIFICATION |

First name & last name *

Prénom

Nom

Birth date *

Day

Month

Year

Place of birth *

Country of birth *

Nationality *

Gender *

National registration number

| CONTACT COORDINATES |

Mobile phone *

Private e-mail *

| LEGAL RESIDENCE | *

Country *

Address 1 *

Address 2

Postal code *

City *

| INVOICING |

Registration as *

Private

Professionnal

Invoicing address *

Legal residence address

Other

Please type in other invoicing address:

Company/Organisation

VAT Number

Street and number

Postal code

City

Country

| BACKGROUND |

| LAST DIPLOMA OBTAINED |

Year of graduation *

Day

Month

Year

Diploma level *

Title of the diploma

Institution *

Other training

| PROFESSIONAL BACKGROUND |

Professional status *

Current job *

Current employer *

Activity area *

Previous professional experience

| MOTIVATION |

Motivation to follow the programme *

Impact of the programme on professional activity *

| SOURCE |

I wish to remain informed of the activities of the Louvain School of Management Alumni

Yes

I have read the registration & cancellation terms & regulations. I commit to pay the programme fee upon receipt of the invoice *

Yes

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