LTCS - Leipzig 2009
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Moritzbastei
Auerbachkeller
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Leipzig
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REGISTER

   
Title  
First name*  
Sure name*  
Date of birth  
Profession  
Institut  
Section  
  Mailing Address  
Hospital Name  
Street*  
Zip code*  
City*  
Country*  
Phone*
 /   
 
Fax
 /   
 
E-Mail*  
Registration
fees *
Physician* / Industry:
€ 650 incl. 19% VAT
Resident / Fellow / Nurse / Subsidized Physician*:
€ 470 incl. 19% VAT after Nov 1, 2009
*To qualify for one of the subsidized registrations for Eastern European physicians, please include a letter from the chief of your department. Registration fees include lunch, breaks, receptions and program handouts.
 
Social Event **
Yes  No  Social Evening in the Moritzbastei (Thursday, Dec 3, 2009)
Yes  No  Final get together in the Auerbachs Keller (Friday, Dec 4, 2009)
** All included in the registration fees.
 
Refunds All cancellation must be submitted in writing and refunds will be subject to
a € 100 administration charge. Cancellations can not be accepted over the telephone. Refunds will not be available after November 13, 2009. You will get
a registration confirmation together with the invoice. 		 
Hotel  
Accommodation
Arrival
    Depart
 
Credit Card*
 Visa   Eurocard/Mastercard American Express
Card Number 
Valid to 
 
Name of the cardholder 
Address in case of differences to the address above  
Notice  
   
  (*) mandatory fields
®werbestudio kombüchen2009