Home About A3MST Committees Scientific Programme President of ESAAM Speakers Abstract Submission Exhibitor Info & Sponsorship Registration Venue Accomodation Previous Congresses General Information COURSE (Medical SPA) Previous Course Program Contact Us	Registration Form Please fill-in the following information and click the 'SEND FORM' button, you will have the chance of previewing the information you have submitted E-mail Title Dr. Prof. PhD Student Other Full Name Name Surname Gender Male Female Institution Adress City Country Please Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Islamic Republic of Iran Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Korea, Republic of Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Lucia Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Helena St. Kitts and Nevis St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (Great Britain) United States United States Virgin Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Wallis And Futuna Islands Western Sahara Yemen Zaire Zambia Zimbabwe Gsm Tel Fax Registration Fee Before Sep 14, 2010 After Sep 14, 2009 Delegate 150 Euro 175 Euro Society Member 125 Euro 150 Euro MSC/PHD Student 125 Euro 150 Euro Company 150 Euro 175 Euro Total Required Payment of Registration : € 0      (V.A.T. included) Accommodation    Yes Hotel Accommodation Name of Hotel Single Double RIXOS GRAND HOTEL ***** 110 Euro 140 Euro MIDAS HOTEL **** 90 Euro 120 Euro PLAZA HOTEL **** 80 Euro 100 Euro Check-in Date 01 02 03 04 05 06 07 December, 2010 Check-out Date 03 04 05 06 07 08 09 December, 2010 Hotel Deposit Fee: One night price as deposit fee is required for each hotel room until September 25, 2010. All hotel rates are per room and on daily basis, breakfast, service charges and V.A.T are included. Total Required Payment of Accommodation: € 0 Flight Details Arrival Date 01 02 03 04 05 December, 2010 Arrival Time Arrival Flight Number Departure Date 02 03 04 05 09 07 08 09 December, 2010 Departure Time Departure Flight Number Payment Payment with Bank Transfer Payment with Credit Card Pay with Bank Transfer Account Owner : Akademi Kongre/ Anti-Aging Account Type : EURO Bank Name : T.C. Garanti Bank Branch : Emek (778) Account No : 9094919 IBAN Code : TR50 0006 2000 7780 0009 0949 19 Account Owner : Akademi Kongre/ Anti-Aging Account Type : TL Bank Name : T.C. Garanti Bank Branch : Emek (778) Account No : 6298877 IBAN Code : TR24 0006 2000 7780 0006 2988 77 * Please indicate the registrar’s name at the bank transfer. * Please note that this is a euro account and the transfers should be made in euro currency. Payment with Credit Card If you choose the option of Payment with Credit Card, you should fill one of the mail order document given below as Word or pdf format in order to send your Credit Card details. Click on one the links below to download the mail order form [opens in a new window]: MS Word Format (.DOC) Acrobat Reader Format (.PDF)
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