Personal information
*This information is required for the further processing of your registration.
Mandatory field Mr./Mrs:* Mr. Ms Mrs.
Academic title:
Mandatory field First name:*
Mandatory field Last name:*
Please give your private address or the address of your institution / company.
Mandatory field Address:*
Mandatory field ZIP:*
Mandatory field City:*
Mandatory field Country:* Germany other:
Mandatory field Phone:*
Fax:
Cell phone:
Mandatory field Email:*
Registration
Physicians, Scientists Permanent ticket Day ticket (03.12.2010) Day ticket (04.12.2010)
Nurses, Students Permanent ticket* Day ticket (03.12.2010)* Day ticket (04.12.2010)*
* Reduced fees can only be applied, after an adequate certificate has been presented to KONGRESS- UND KULTURMANAGEMENT GMBH. This can be submitted via fax to +49 (0) 3643 2468-31, via mail to P.O. Box 36 64, 99407 Weimar, Germany or via email to registration@ecim-congress.org .
Case conferences
A separate registration for attending the Workshops is necessary. Please be aware that the number of participants for each c ase c onference is limited. Participation is guarantied only after you received a confirmation from KONGRESS- UND KULTURMANAGMENT GMBH.
Case conferences Der geriatrische Patient I (in German) Der geriatrische Patient II (in German) Inflammatory Bowel Syndrom I (in English) Inflammatory Bowel Syndrom II (in English)
ZAEN events
Separate registration is required for participation in ZAEN-events. Participation is guarantied only after you received a confirmation from KONGRESS- UND KULTURMANAGMENT GMBH.
Events: ZAEN I: 03.12.10, 14:00-17:00 (preliminary) ZAEN II: 04.12.10, 10:30-12:00 (preliminary) ZAEN III: 04.12.10, 13:30-17:00 (preliminary) ZAEN-Symposium: 04.12.10, 13:30-15:00 (preliminary)
Social Get-together
Social Get-together; December 03, 2010; participation fee 30,00 €:
Number of participant:
Payment
Mandatory field Payment by:* Credit card Automatic debit transfer systems
Credit card
Credit card: American Express Mastercard VISA
Card holder:
Card number:
Expires:
Automatic debit transfer systems
Please note, that the payment by automatic debit transfer system is only possible from a bank account in Germany.
Account holder:
Account number:
Bank code (BLZ):
The fees for participating in the scientific program and workshops, and the handling fees are charged in the name and on account KONGRESS- UND KULTURMANAGEMENT GMBH (KUKM) and do contain 19 % VAT. The tax ID number of KUKM is DE158265638.
More informationen
Mandatory field Field of activity:* medical practice employed in a medical practice employed in a hospital research pharmaceutical industry pensionary continuing education other:
other:
Mandatory field I work as:* general practitioner surgeon gynaecologist alternative practitioner internist cardiologist neurologist oncologist nurse physiotherapist pain therapist urologist other:
other:
Mandatory field I’ve heard from the congress via:* internet newsletter newsletter by a association congress announcement congress poster advertisement in a journal preliminary congress program company>
Name:
Terms and Conditions
Once you have sent the completed registration form, your registration is binding. Further information on prices and deadlines can be found on www.ecim-congress.org . Reduced fees can only be applied, after an adequate certification has been presented to KONGRESS- UND KULTURMANAGEMENT GMBH. This can be submitted via mail to P.O. Box 36 64, 99407 Weimar, Germany or via email to registration@ecim-congress.org .
In case of non-participation, there will be no money refund. In the event of a change of registration with KONGRESS- UND KULTURMANAGEMENT GMBH a processing fee of 15,00 EUR is charged. The charges for rebooking are 15,00 EUR.
By registering, the participant agrees that he/she will not make any claims toward the host if the conference in consequence of political, commercial or natural forces will be cancelled or altered in its program. Neither the host nor KONGRESS- UND KULTURMANAGEMENT GMBH can be made liable for lost items, accidents or damages to persons and things, whatever the cause. Participants (and the person accompanying) to the conference and the social events attend at their own risk and responsibility.
Mandatory field I confirm that I have read the terms and conditions:* I fully understand and accept them.
