Application for an engraved stone in Walk of Fame @ Wageningen Campus Your data Name of applicant* Contact person Email* Contact person’s phone number Relationship with Wageningen University & Research* -- Select -- Employee(s) Department/unit of Wageningen University & Research Students organisation Graduate(s) Business relation Partner organisation Other Please explain 'Other' * Invoicing address* Send the invoice to ... Applicant is part of Wageningen University & Research and will provide an in company invoice number (EBS) after the application has been accepted Name* Contact person* Street + number* Postal code* City* Design of the stone: planned text and description of images* Attachment (PDF or picture): Explanation of the memorable moment Size of the stone* -- Select -- 40 x 40 x 3cm 40 x 80x 3cm 40 x 120 x 3cm 80 x 80 x 3cm Preferred date of placement* Wishes with regards to the placement ceremony i Number of persons, catering, presence of persons involved e.g. prize winner, etc. Privacy* I agree with the use of my personal data for the purpose detailed above. The privacy statement of WUR applies to this use of your personal data. Read the privacy statement Twitter Whatsapp Linkedin Email
