Mercedes-Benz Driving Events 2012/2013 - 300 Multiple Choices

154
01 onroad summer 02 offroad summer 03 travel experience
Registration for the summer 2012 and winter 2012/13 Mercedes-Benz Driving Events.
Mercedes-Benz Driving Events, Münchner Straße 24, 85774 Unterföhring, tel. no. +49 89 9506051, fax +49 89 9506079
Participant‘s details/address for confirmation of registration Invoice address (if different from address opposite) Payment
Surname, first name
Company
by bank transfer on receipt of invoice
Street, house number
Contact
by credit card
Visa Eurocard
Post code/town/country
Street, house number
Card no.
Date of birth
Fax
Post code/town/country
Valid until
Card verification number
Telephone - private
Business
Please send all literature to the invoice address.
with voucher
(last three digits of the number in the signature strip)
Email address
Send literature for the second participant to their address.
Voucher no.
issued on
Make/model of your personal car
Details of second participant (if you wish to register a second person)
Surname, first name
Street, house number
Post code/town/country
Date of birth
Fax
Telephone - private
Business
Email address
Desired training
Data Protection – Declaration of Consent
We would like to provide you with individual information
and advice. Therefore, we request your consent to use
your data. We will treat it confidentially and handle it
with due care.
I agree to allow Daimler and its authorized sales and service partners
to process and use my contact information, data on my vehicle and on
services that I have used in order to provide me with written information
and advice on products and services of Daimler AG and companies
associated with it, as well as for market research. Data can be
disclosed to Daimler AG, selected dealers/service partners within the
Daimler sales and service organization, and market research institutes
for these purposes.
I also agree to be contacted for the above purposes by
the following means:
by telephone
by e-mail
If you do not want us to process and use your data, for legal reasons
we will unfortunately no longer be allowed to inform you about products
and services.
If you do not wish to receive information by post, please
check this box
If you wish to revoke your declaration of consent at a later date, please
contact Daimler AG HPC V420, 10878 Berlin.
Training no./name .
Venue
Desired date
Alternative date
Date of additional overnight stay (if desired)*
If you have provided us with consent to contact you at a previous time, please renew it; otherwise, for legal reasons, we will no longer be allowed to
provide you with information in the future.
If you no longer wish to be contacted in the future, you can object to the use of your data for provision of information on products, services and
market research. Please contact: Daimler AG, HPC V420, 10878 Berlin.
I recognise the conditions for participation on pages 157 and 158, including the cancellation conditions, as binding.
*Additional overnight stays are payable directly at the hotel.
Place, date
Signature