Personal details and address for correspondence
Title: Prof    Dr    Mr    Mrs    Ms    
First Name:
Family Name:
Name for Badge:
BIG registration number:
  (for Dutch GAIA registration only)
Institution/Hospital:
Address1:
Address2:
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A) CONGRESS <15-06-2012 >15-06-2012
ESCTAIC member € 250 per person € 280 per person
Non member € 300 per person € 330 per person
Accepted free paper € 220 per person € 220 per person
One Day Registration

Wednesday

 €   75 per person
One Day Registration

Thursday

 € 150 per person
One Day Registration

Friday

 € 150 per person
 
 
B) TUTORIAL    
IHE phys. Modelling

ESCTAIC member		 € 70 per person €  80 per person
Non member € 90 per person € 100 per person
 
C) WORKSHOPS    
ADAM AIMS OR

ESCTAIC member
€ 15 per person
€ 20 per person
Non member € 20 per person € 25 per person
 

  I will attend the general assembly and congress dinner Friday 8th   

 

 (incl.in full registration    € 35  for day registrants)

 
HOTEL ACCOMODATION
The congress hotel will be the .

Hotel Accommodation page

 
All Payments should be made in Euro to:

 
Stichting Onderwijs Research Fonds Anesthesiologie   
Bank: ING, Amstelveenseweg 500, 1081 KL City: Amsterdam  remarks: esctaic 2012 IBAN: NL30INGB0004936101
BIC:   INGBNL2A
voor nederlandse betalingen :  ING  Rekeningnummer: 4936101 t.n.v. bovengenoemde Stichting te Amsterdam  o.v.v.  esctaic 2012
 
You will receive confirmation by email, after receiving your payment we will send you
a receipt per email. A printed document will be issued at the congress.
 
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