Registration Form

Registration Form

Participant Details

Fields marked with * are mandatory. For form submission to be successful, please fill-in all mandatory fields.

Mailing Information

Category Office Residence

Department

Organization / Institution

Address *

City *

Postal Code *

State/Prov.

Country *

E-mail *

Mobile

Telephone

Fax

Accompanying person(s) information

A. Adult

First Name Last Name

B. Children

First child

First Name

Last Name

Age

Second child

First Name

Last Name

Age

Payment Method

Please select your method of payment in the options offered below:

Method of payment Online secure credit card Bank transfer *

Registration Replacement & Cancellation Policy

Changes in registration will only be accepted if sent in writing to FREI S.A.
Replacements (=delegate name change) of confirmed registrations after July 01, 2012 are subject to an administrative fee of 40€ per participant.
Cancellations of confirmed registrations are subject to a charge of 100€ per participant provided the cancellation is received no later than June 01, 2012.
For cancellations received after this date no refunds will be made. All refunds will be processed after the Congress.

Acceptance

I accept the Registration Terms & Conditions *

Registration to the Congress implies the acceptance of Registration Terms & Conditions. Please kindly read them carefully.

If not ticked, the registration form will not be considered.

Thank you for submitting this form. The information you submitted has been received by the Congress Secretariat and once processed, we will contact you.

Click here to proceed to the VeriSign Secured online (128 bit SSL) banking payment system.

The payment page will open in a new window within your web browser. There are two stages where you need to submit information. In the first and second stage you will not be required to disclose sensitive information and as such you will be transferred to the secure online banking system page in the next page.

Registration for Specialists, Residents and Other Health Professionals includes:	Registration for Accompanying persons includes:	Registration for Students includes:

Attendance to the Congress scientific sessions Entrance to the Exhibition & Poster area Congress bag & documentation Certificate of attendance Coffee Breaks Welcome Reception / Social Events	Opening Ceremony Cultural Visit Welcome Reception Social Events	Attendance to the Congress scientific sessions Entrance to the Exhibition & Poster area Programme at a glance Certificate of attendance

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