REGISTRATION FORM
PLEASE FILL THE FORM  

 

SEX:

LAST NAME:

NAME:

INSTITUTE:

SPECIALTY:

DEPARTMENT:

ADDRESS:

CITY:

POSTAL CODE:

COUNTRY:

FAX:

  E-MAIL:

Registration Fees

Participation Fee  
Physisians & Scientists  450 Euro plus VAT 23% 
Nurses Students  60 Euro plus VAT 239% 
   




Accommodation Hotel  (See details in General information)

Hotels

King George Palace 180 Euro SGL or DBL
Classical Athens Imperial 120 Euro SGL or DBL

 


Please Register person(s) X =
for Accommodation room(s) X . =

for Accompanying Persons person(s)X=
Grand Total =

The Accommodation package includes: 4nights in the hotel of your choice including Breakfast

 


Payment
(ALPHA BANK Mitropoleos str., Thessaloniki - Greece)

IBAN:GR8401407000700002310007088, Swift code: CRBAGRAAXXX

in favour of George Samaras. Deadline for this way of payment is 10/1/2011

All payments must be forwarded in EURO and should be net of Bank charges.

On all remittances the name of the sender should be clearly mentioned as well as the payment description (e.g. Mr. A. Sender, EURO 100, representing: 50 registration fees 50 hotel accommodation deposit for the QOL Conference).


Deadline for this way of payment is December 15, 2007
All payments must be forwarded in EURO and should be net of bank charges.
On all remittances the name of the sender should be clearly mentioned as well as the payment description (e.g. Mr. A. Sender, EURO 100, representing: 50 registration fees 50 hotel accommodation deposit for the QOL Conference.
I have remitted the sum of EURO NET OF BANK CHARGES on in the name (remitter) through (name of Bank)
CREDIT CARD
(only VISA and MASTERCARD are accepted)
For security reasons, if you select this way of payment you will receive the authorization form from the Secretariat by email or by fax.
For any information concerning the registration please contact the Secretariat

FOR THE CONFIRMATION OF THE RESERVATION YOU HAVE TO TRANSFER THE FULL AMOUNT

CANCELLATIONS
Written cancellation TILL 15/12/2010 FULL REFUND MINUS THE BANK EXPENSES
Written cancellation AFTER 15/12/2010 NO REFUND