Annual report order

Request to receive annual reports by post

GBL's annual report		fr *	nl *	en *
2001	in				Copies
2002	in				Copies
2003	in				Copies
2004	in				Copies
2005	in				Copies
2006	in				Copies
2007	in				Copies
2008	in				Copies
2009	in				Copies
2010	in				Copies

Electrafina's annual report
1996	in				Copies
1997	in				Copies
1998	in				Copies
1999	in				Copies
2000	in				Copies

I wish to receive the next release of the annual report (2011)
GBL	in				Copies

* fr = français; nl = nederlands; en = english

*Would you please complete all the data with a () in order to allow to send by post**

First name		(*)
Last name		(*)
Company
Jobtitle
Enter your Email address
Telephone
Fax
Address		(*)
Zip code		(*)
Area		(*)
Country		(*)
(*)Mandatory fields