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Registration
Registration deadline extended until August 14th 2016.

Last Name*:
First Name*:
Title*:
Position*:
Institute:
Department:
University/Company:
Street:
Zip or Post Code:
City*:
Country*:
Telephone:
Fax:
E-mail*:
 
I will attend the symposium*
€50 all students (including PhD students/MD students); €150 all others




 
I will attend the congress party on September 10, 2016*
€25 all students (including PhD students/MD students); €30 all others:
 
 
I need a certification for CME*(18 CME points for three days)
 
 
Registration fees
€ 50 for students (including PhD students/MD students), € 150 for all others
 
Congress Party
€ 25 for students (including PhD students/MD students), € 30 for all others
 
Payment
Please transfer the fees for registration and congress party to the following account:
Recipient: Universitätsklinikum Erlangen
Bank: Stadt- und Kreissparkasse Erlangen
IBAN: DE84 7635 0000 0000 0464 04
BIC: BYLADEM1ERH
Reason for payment (Verwendungszweck): 33452008 GK Symposium 2016 (last name, first name must be included !!!)
 
For international bank transfers please use the following International Bank Account Number and the Bank Identifier Code
 
IBAN: DE 84 76350000 0000046404
BIC: BYLADEM1ERH

We will confirm your registration by e-mail after receipt of payment. Payments can only be reimbursed if cancellation has been received before August 8, 2016.

Additional Comments:
 
 

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