4th European Congress of Oto-Rhino-Laryngology, Head and Neck Surgery
71. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf-und Hals-Chirurgie
You might also print this form and return it before March 1st, 2000 to:
K.I.T. GmbH
Ref: "EUFOS"
Karl-Liebknecht-Strasse 5
D-10178 Berlin, Germany
Telefon: ++49 (0)30 /246 03 0
Telefax: ++49 (0)30 /246 03 200
For additional delegates, please fill out / print this form twice.
| Title | Prof Dr Mr Mrs |
| Surname | |
| First Name | |
| Department / Position | |
| Hospital / Company | |
| Address - Street | |
| Country / Postal Code / City | - - |
| Telephone |
-
-
(country code/area code/number) |
| Fax |
-
-
(country code / area code / number) |
| Accompaying Person |
| Please check appropriate box. | Before October 31, 1999 |
Before January 31, 2000 |
After February 1, 2000 |
| Delegate | EUR 350 | EUR 400 | EUR 480 |
| Reduced Fee * | EUR 170 | EUR 200 | EUR 240 |
| Subtotal A: | |||
* (Residents, Retired colleagues, Students, Non-academic university staff. A photocopy of a current registration card or a letter from your department must be sent to K.I.T., see address above).
| Category chosen/Deposit | A: EUR 250 | B: EUR 200 | C: EUR 150 |
| Preferred hotel: | 1st choice: |
2nd choice: |
3rd choice: |
| Preferred room: |
Single room |
Double room |
non-smoking |
| Arrival / Departure: | late arrival (after 6.00 p.m.) | ||
| Arrival date | May 2000 | ||
| Departure date | May 2000 | ||
| Number of nights | |||
| Subtotal B: | |||
| Berlin Orientation Tour | Saturday, May 13, 2000 from 1.00 p.m.–4.30 p.m. | |
| EUR 23 x No.of persons | Total EUR: | |
| Berlin Orientation Tour | Sunday, May 14, 2000 from 9.00 a.m.–12.30 p.m. | |
| EUR 23 x No.of persons | Total EUR: | |
| Berlin Orientation Tour | Sunday, May 14, 2000 from 2.00 p.m.–5.30 p.m. | |
| EUR 23 x No.of persons | Total EUR: | |
| Behind the tourist scene | Monday,May 15,2000 from 9.00 a.m.–1.00 p.m. | |
| EUR 26 x No.of persons | Total EUR: | |
| Berlin 2000 | Monday, May 15, 2000 from 2.00 p.m.–5.00 p.m. | |
| EUR 19 x No.of persons | Total EUR: | |
| Pergamon Museum | Tuesday, May 16, 2000 from 9.30 a.m.–12.30 p.m. | |
| EUR 22 x No.of persons | Total EUR: | |
|
On the Spree, under the bridges |
Tuesday,May 16,2000 from 1.00 p.m.–5.00 p.m. | |
| EUR 50 x No.of persons | Total EUR: | |
|
Charlottenburg Castle Egyptian Museum |
Thursday, May 18, 2000 from 9.30 a.m.–12.30 p.m. | |
| EUR 25 x No.of persons | Total EUR: | |
|
Post-congress tour DRESDEN |
Friday, May 19, 2000 from 9.00 a.m.–7.00 p.m. | |
| EUR 92 x No.of persons | Total EUR: | |
|
Post-congress tour SPREEWALD |
Friday, May 19, 2000 from 9.00 a.m.–7.00 p.m. | |
| EUR 86 x No.of persons | Total EUR: | |
| Subtotal C: | ||
| Opening Ceremony | Saturday, May 13, 2000 from 5.00 p.m.–7.00 p.m. | |
| EUR 0 x No.of persons | Total EUR: | |
| Deutsche Oper “FAUST” | Sunday, May 14, 2000 from 6.00 p.m.–9.30 p.m. | |
| Category A | ||
| EUR 81 x No.of persons | Total EUR: | |
| Category B | ||
| EUR 65 x No.of persons | Total EUR: | |
| Category C | ||
| EUR 43 x No.of persons | Total EUR: | |
| Category D | ||
| EUR 18 x No.of persons | Total EUR: | |
| Philharmonie | Monday, May 15, 2000 from 7.30 p.m.–9.00 p.m. | |
| EUR 40 x No.of persons | Total EUR: | |
| Boat Cruise to Potsdam | Wednesday, May 17, 2000 from 2.30 p.m.–6.30 p.m. | |
| EUR 55 x No.of persons | Total EUR: | |
|
Informal Dinner at Palais am Funkturm |
Wednesday, May 17, 2000 from 7.00 –10.00 p.m. | |
| EUR 55 x No.of persons | Total EUR: | |
|
Staatsoper Berlin “THE MAGIC FLUTE” |
Thursday, May 18, 2000 from 7.00 p.m.–10.00 p.m. | |
| Category 1 | ||
| EUR 82 x No.of persons | Total EUR: | |
| Category 2 | ||
| EUR 65 x No.of persons | Total EUR: | |
| Category 3 | ||
| EUR 55 x No.of persons | Total EUR: | |
| Category 4 | ||
| EUR 34 x No.of persons | Total EUR: | |
| Category 5 | ||
| EUR 21 x No.of persons | Total EUR: | |
|
Deutsche Oper “THE FLYING DUTCHMAN" |
Thursday, May 18, 2000 from 7.00 –9.00 p.m. | |
| Category 1 | ||
| EUR 81 x No.of persons | Total EUR: | |
| Category 2 | ||
| EUR 63 x No.of persons | Total EUR: | |
| Subtotal D: | ||
| 1. | Rhinoplasty | 20 EUR |
| 2. | Laser surgery (Charité) | 20 EUR |
| 3. | Plastic surgery | 20 EUR |
| 4. | Laser surgery (Benjamin Franklin) | 20 EUR |
| 5. | Neck dissection | 20 EUR |
| Subtotal E: |
| Subtotal A: | |
| Subtotal B: | |
| Subtotal C: | |
| Subtotal D: | |
| Subtotal E: | |
| Total Amount: |
Payment must be made in EUR to K.I.T. GmbH only.
All bank charges must be paid by the transmitter.
Please indicate „EUFOS ”and your name and affiliation on all money transfers.
Hereby I confirm the above bookings.
I hereby certify that I have read the terms of the registration as well as the cancellation clauses, which I accept without restriction.
The total amount of will be paid by:
| Certified, guaranteed-payment cheque or bank draft I will sent to K.I.T. |
|
Bank-to-bank transfer to K.I.T. GmbH |
|
| Credit Card: American Express Diners Club Eurocard / Mastercard Visa Charge my credit card number: Expiration date: Name of cardholder: You might also print the credit card information and fax or mail it to K.I.T. To print prepared form click here. How to print: Click on form, choose File / Print frame from the menu. THIS FORM CANNOT BE SENT. Please visit www.eufos.org for information on the upcoming EUFOS congress |
