Congress registration form

Passport number:
Dr.   Prof.   Mr.  Mrs. Ms.
Surname:
First Name:
    
Member of
the Association:
Address:
City:
ZIP:
Country:
Phone:
Fax:
E-mail:


Congress fees

 
Before 1st May
After 2nd May
Members of Acupuncturist Associations and Master or postgraduate students of acupuncture
250€
300€
Discount on fee when signing up for more than on workshop
225€
270€
Non Members
350€
400€
Discount on fee when signing up for more than on workshop
315€
360€
TOTAL FEE: €
PLACES RESERVED ON A FIRST COME, FIRST SERVED BASIS.


Workshop

10% discount on congress fee when signing up for more than one workshop.

 
Before 1st May
After 2nd May
1 Workshop
75€
100€
2 Workshop
125€
175€
3 Workshop
175€
200€
Indicate which workshop/s (A, B, C, D, E or F) you wish to sign up to:
TOTAL WORKSHOP: €
THE PLACES ARE LIMITED TO 30 PARTICIPANTS FOR WORKSHOP.
THESE PRICES CANCEL THE ONES ON THE DRAFT PROGRAM.


Accommodation

Arrival on:
Departure on: 

Included breakfast and VAT (7%).

Single Room
Double Room
Nights
H. Mikado***
96€
116€
x nights
H. Tres Torres ***
106€
120€
x nights
 
 
Acompanying person:
Surname:
First Name:
TOTAL HOTEL: €


Formal Dinner

FORMAL DINNER 4th June: 60 €
No  Yes

TOTAL FORMAL DINNER: 60€ x person(s) = €


Total

FEES + WORKSHOP + HOTEL+ FORMAL DINNER: €


Method of payment

Select a method of payment.

Bank transfer indicating the name of the attendant to:

 FIBANC: 0186-9900-11-2803274271
Reference: INTERACUPUNCTURE2005
Account holder: MEDIVIATGES

Once the bank transfer has been made, a copy of transfer document and the Reply Coupon should be sent to Conference Secretariat (fax +34 93 567 88 61).
Credit card:
American Express    Mastercard    Visa    Diners Club
Credit card nº.:
Expiry date:
Card holder‘s name:
Amount:
 €

Cancellations

Until 21st April 75% refund.
After 22nd April 50% refund.
From 13th April to 3rd June no refund.



PDF format also available.

Your personal data will be included in an electronic file belonging to MEDIVIATGES, S.A. for the purposes of providing you with the requested services and informing you of our products and services. Moreover, we inform you that your data may be facilitated to the companies and professionals involved in providing the requested services, as well as to the Col.legi Oficial de Metges de Barcelona (Medical Association of Barcelona) and entities which form part of that Association, for the purposes of supplying you with information regarding their products and the services of the Guide of associated services that might be of interest to you. You may exercise your right to access, cancellation, rectification and opposition in writing to the address Passeig de la Bonanova, 47, 08017 Barcelona, clearly indicating your name, surname(s), address and the nature of your request. (reference: "handling of data").
 
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Last update: 06/17/2005