Registration: First Integrative Course on
Spasticity Management
10 - 13 October 2010, Bodrum (
Please print in block
letters, sign and fax, e-mail or airmail to the address below or download at www.vitalmedbodrum.com
Title e.g. Mr/Ms __________ First
name_______________________ Family Name_______________________
Institute_____________________________
Dept. _________________________ Tel; (office hrs)___________________
Street __________________________________ City ____________________________ Country_________________
E-mail address______________________________________________ Fax(optional)_________________________
Discipline: 1.
Specialist (pls. specify) ______________________________________ÿposter / ÿoral presentation
2. Assistant/trainee (pls. specify) _________________________________
3. Other
(pls. specify) __________________________________________
Registration
Fees: Please tick the appropriate box
|
|
Until July
1, 2010 |
After July
1, 2010 |
At the
Congress |
|
Medical
doctors/Therapists |
ÿ Euro 350 |
ÿ Euro 400 |
ÿ Euro 450 |
|
Assistants/Trainees |
ÿ Euro 275 |
ÿ Euro 325 |
ÿ Euro 375 |
Accommodation: Please indicate the requested room(s)
/ number of nights
Date of
Arrival: _____________________________ Date of Departure:_________________________________
|
Accommodation, Prices per room
(applicable from 9/10 to 14/10) |
5* Yasmin
Resort * All Inclusive |
Complete only when staying outside Yasmin Resort. Number days attending the course
(without hotel) (…..) |
|
Single room |
(….) nights at Euro 80 per room |
This supplement is needed for daily
hotel admission |
|
Double room |
(….) nights at Euro 95 per room |
Amount € 20 per person per day |
|
Triple room |
(….) nights at Euro 135 per room |
Note: The Academic program is 3
days! |
* All bookings in the Congress hotel are subject to availability and the organisers may change any booking to another hotel if
necessary
Flight
Details: Please provide flight details below, (or
send no later than 30th Sept by email).
Arrival Flight No:_______________ Time:
________ Departure Flight No:_______________ Time;__________
Airport
Transfers for …… person(s)
(€ 120 per person, to and from the hotel)
Calculation
of amount due: Signature:
Registration fee € …..………..….
Hotel / supplement € …..………..….
Turkish night (€
50 pp) € …..………..….
Transfers (€
120 pp) € …..………..….
Boat trip non-participant (€ 50 pp) € ……………….
Total amount due € …..………..….
Payments
must be made in Euro. Please tick the preferred payment method
( ) Bank
transfer to
Bank Name: Finansbank Bodrum Branch 481 (Şubesi) Account name: VitalMed Ltd. Sti.
Account nr: 10665879 Euro Reference: Spasticity course 2010
IBAN
TR470011100000000010665879; Swift
code: FNNBTRISBOD Bank code: 111
Please fax
the bank transfer paper together with your registration form
( )
Credit Card: MasterCard or Visa
I authorize you to debit my Master ( ) / Visa (
)
Card No.:
…..……………-…..………..….-…..………..….-…..………..…. expiry date ……../…….. Card
Validation Code (CVC); ……………
Name and address of credit card holder if different from
that on registration form: …………………..…………………………………………
Correspondence Address: VitalMed Bodrum: Davutlar sokak
13, 48400 Bodrum, Muğla , Turkey
Tel : + 90 (0)252 316 5107 Fax:
+90 (0)252 316 5143 Email: vitalmed@vitalmedbodrum.com
www.vitalmedbodrum.com
Cancellation policy: Please
see General Information.