Physiotherapist Daily Registration Form

Physiotherapist Daily Registration Form

23-27 EYLÜL 2014
İ Z M İ R K AYA K O N G R E M E R K E Z İ
PHYSIOTHERAPIST DAILY REGISTRATION FORM
Name :…………………………………………………………Surname:……………………………………………………...........................……
Title :.……………………………………............. Mr.:
Ms./Mrs.:
Institution:.…………………………………………...............................................................................................................................................
.............
Address :………………………………………………………………………………………………………………………………………………………………………………..............…
City :……………………………………………………………………………………………. Tel :……………………………………………………………………...........................…
Fax :………………………………………………………………………………E-mail:………………………………………………………………………………………………….…..
Billing address:…………………………………………………………………………………………………………………………………………………........................................
………………………………………………………………………………………………………………………………………………………………………………………………………...…..
REGISTRATION INFORMATION
REGISTRATION FEES
September 10 and before
September 10 and after
STUDENT
50 TL
70 TL
PHYSIOTHERAPIST
150 TL
200 TL
Ø Registration fees do not include 18% VAT.
* This registration is only valid for attendence on September 26, 2014.
whose abstracts has been accepted etiher as oral or as poster, should register for the congress at least
* Physiotherapists
from the daily registration fee.
Ø Registration
Kayıt ücre ne,
öğle
yemeği,
kahve
molaları,
ve genel
bilimsel
ak vitelere
ka lım,and
sergi
alanlarına
giriş,name
yakabadges,
kar ,
fees
inculde
lunch,
coffee
breaks,
admission
to scientific
sessions
exhibition
area,
certificate
participation
and congress
materials
ka lım seroffikası,
kongre materyalleri
dahildir.
Registration Fee
Participant x
.................................................... TL
VAT (18%)
KDV
(%18)
.................................................... TL
Grand Toplam
Total
Genel
.................................................... TL
By bank
transfer
Banka
Havalesi
ile
By Credit Card
Credit Card Details
Visa
Master Card
Credit
Kart
NoCard No
CVV. No:
Method
of Payment
Ödeme Şekli
Name & Surname
Exp. Date:
/
Signature
İPTAL KOŞULLARI
TERMS OF CANCELLATION
Ø All cancellations must be made in writing.
Ø Cancellations before August 10 are refundable. Cancellations after this date will be non refundable however name changes
will be possible.
Ø All refunds will be made after the Congress.
BANKAACCOUNT
HESAP BİLGİLERİ
BANK
INFORMATION
Hesap
Account
AdıName
: Ege Üs Kongre Danışmanlık Turizm ve İnş.San.Tic.Ltd.S
Bank &
Branch
: Türkiye İş Bankası Alsancak Branch(3401)
( 3401)
Banka
Adı
Account
(TL)
TL
HesapNo
Numarası
: 960532 IBAN : TR62 0006 4000 0013 4010 960532
mu doldurduktan
sonra
Sekreteryası’na
fakslayınız.
Please
fill in this form and
fax Kongre
it to the Congress
Secretariat
+90 (0 232 464 29 25)