Advanced Symposium on Congenital Heart Disease in the Adult

Registration Form

Delegate

Surname:

First Name:

Title:

Institution:

Hospital:

Department:

Address

No:

Street:

City:

State:

Country:

Postal Code:

Tel:

Fax:

Cell Phone:

E-mail:

Accompanying Persons

Number of accompanying
persons:

Please list the full names of all
accompanying persons,
separated by commas:

Registration Fees

Please check the appropriate box

Physicians

Fellows, Technicians, Nurses, Students

Accompanying Person/s

700 €

500 €

100 €

After June 30, 2008

Physicians

Fellows, Technicians, Nurses, Students

Accompanying Person/s

Payment

Unless you are planning to submit your payment online, please send the registration form
with the bank transfer slip to the secretariat of the Symposium,(Fax: +30 2310 240669) indicating the total amount of registration fees

Option 1

Option 2

Option 3

When making out the cheque, please ensure that your name, address and
telephone number are printed clearly on the back.
Any bank charges should be paid by the delegate.

Artemis Thoma, ALPHA BANK, Branch: 704
Address: 45, Tsimiski St. 54623 Thessaloniki, Greece
Tel.: 0030 2310 227823, 227852.
Account Number: 704002320001611
IBAN: GR52 0140 7040 7040 0232 0001 611
SWIFT No: CRBAGRAAXXX
The full name must be indicated in the bank transfer slip.
Any bank charges should be paid by the delegate.

Any bank charges should be paid by the delegate.

- By Cheque payable to "THESIS - ARTEMIS THOMA".

- By bank transfer into the following account:

- By credit card

Cancellation Policy

50% of the registration fees will be refunded if notice of cancellation is sent to ACHD 2008 in written form, before 30th of June, 2008.
Cancellations after this date are not refundable. However, the registration may be transferred to another person, at no extra charge. Please inform if you plan to send a deputy.

I Agree

€

If option 3 is checked you will be redirected to thesis-pr.com secure website to complete your payment.
You will be asked for credit card details.
Please keep in mind that the credit card holder information should be the same as that provided in the registration form.

Pre-registrations have been closed.
Delegates can register on sight at the location of the Symposium.