ESC Bonus Card Reduction Registration Form (one form per by oqp13905

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									                                                     Fields marked in red can be completed electronically!


                                                     Barcelona, Spain, 25 – 28 May 2010
european stroke conference

            Registration Form (one form per participant)
            J Mr            J Mrs          J Prof.      J PD          J Dr                              Please return before 18 March 2010 to:
            Family name (please underline) / First name, initial(s)
                                                                                                             ESC 2010
            Hospital / Institute / Company                                                                   c/o Congrex Switzerland Ltd.
                                                                                                             Association House
            Department                                                                                       PO Box
                                                                                                             4002 Basel, Switzerland
            Street, No.
                                                                                                             Fax +41 61 686 77 88
            PO Box                         Postal code / Zip code                        City

            Country                                                       State / County (where applicable)                                E-mail

            Telephone business                                            Fax                                                              Telephone home


              Invited by / Part of group

                                                                                                                     until             19 March –                as from                           Total
              Conference Registration                                                                            18 March 2010         6 May 2010              7 May 2010
             100    Participants                                                                                    € 550                 € 650                    € 700
             150    Participants (ESO Members) with chosen benefit “reduction of € 40 to the ESC registration”      € 510                 € 610                    € 660
             200    Junior delegates (born after 31.12.1976)  proof (copy of passport) required                     € 300                 € 450                    € 500
             220    Senior delegates (born before 01.01.1944) proof (copy of passport) required                     € 300                 € 450                    € 500
             250    Nurses and AHP                            proof of employment status required                   € 300                 € 450                    € 500
             300    Students                                  proof of undergraduate student status required         Free                  Free                     Free
             400    Accompanying persons                                                                            € 50                  € 50                     € 50
            The fees for conference participants include: Congress bag, Final Programme / Abstracts on CD-ROM, Admission to all scientific parts of the conference,
            Welcome Reception, Coffee breaks, Lunch packs on Wednesday and Thursday, 1-year online subscription of Cerebrovascular Diseases
            The fees for accompanying persons include: Welcome Reception, Sightseeing Tour

              ESC Bonus Card Reduction                                                                                                                                Points
             How many points do you want to use to reduce your registration fee?
             (A minimum of 16 required and a maximum of 30 redeemable)
              Teaching Courses (Tuesday, 25 May 2010)
             13.00 – 15.00      500   Teaching   Course    1:   Difficult decision making revisited                                        €    40
                                510   Teaching   Course    2:   Stroke mimics and stroke-like episodes                                     €    40
                                520   Teaching   Course    3:   Current stroke prevention strategies                                       €    40
                                530   Teaching   Course    4:   Stroke in young adults                                                     €    40
                                540   Teaching   Course    5:   Stroke and vision                                                          €    40
             15.30 – 17.30      550   Teaching   Course    6:   Stroke syndromes                                                           €    40
                                560   Teaching   Course    7:   Post-stroke complications                                                  €    40
                                570   Teaching   Course    8:   What causes lacunar strokes?                                               €    40
                                580   Teaching   Course    9:   Stroke and headache                                                        €    40
                                590   Teaching   Course   10:   Hemorrhagic strokes                                                        €    40
              Workshop Neurosonology (Wednesday, 26 May 2010)
             14.00 – 18.30      420   Workshop Neurosonology (limited space, registration obligatory)                                      € 40
              Nurses and AHP Meeting
              450   Participation, included in the registration fee                                                                         Free
              Social Events and Tours                                                                                                                       No. of persons
              600   Welcome Reception (Tuesday, 25 May 2010)                                                                                Free
              610   Old City “Gothic Quarter” Walking Tour (Wednesday, 26 May 2010, 13.00 – 17.30)                                         € 35
              615   Old City “Gothic Quarter” Walking Tour for accompanying persons, included in the registration fee                       Free
              620   Barcelona Panoramic Tour (Thursday, 27 May 2010, 9.00 – 13.00)                                                         € 35
              630   The Modernist World of Gaudi Tour (Thursday, 27 May 2010, 13.30 – 17.30)                                               € 50
              640   Montserrat and the Wineries (Friday, 28 May 2010, 9.00 – 17.00)                                                        € 120
            The total amount will be paid as follows:                                                                                                                      Total                      0
               Bank transfer – free of charge for recipient – to UBS AG, Basel, Switzerland,
               BIC UBSWCHZH80A, IBAN No. CH82 0023 3233 5030 1079 P (Congrex Switzerland Ltd., ESC 2010)
               Bank cheque No. ___________________ enclosed
                                                                                             CVV2 Code*                                                                  CVV2 Code*
               Credit card     Visa      Mastercard       American Express                   (VISA/Mastercard, last 3 digits in the                                      (American Express, last 4 digits on the front
                                                                                                                            signature field on your credit card)         of your credit card on the right hand side)
            No.                                                                       Expiry date                                                  * Required field                                   * Required field


            Cardholder’s name:                                                        Date:                                 Signature:
            Cancellation / Refund Policy: Refund of registration fees, less 25% administrative charges, can be applied for in writing until 24 March 2010 to the Administrative
            Secretariat in Basel. After this date no refund will be possible. Name Changes: For any change of names, a fee of € 20 will be charged. Onsite changes of name badges
            due to incorrect submission of names and/or address data will be charged with € 10.
   A27344




            The participant acknowledges that he / she has no right to lodge damage claims against the organisers should the holding of the conference be hindered or prevented
            by political events (such as acts of terrorism, danger of hostility, war, etc.) or by unexpected economic events or generally by force majeure, or should the non-appearance
            of speakers or other reasons necessitate programme changes. With his / her registration, the participant accepts this proviso.

								
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