5th INTERNATIONAL WORKSHOP WORKSHOP ON INTERIM PET IN LYMPHOMA September 1919-20, 2014
« PALAIS DE L’EUROPE L’EUROPE » MENTON – FRENCH RIVIERA REGISTRATION FORM – Please read pages 1 and 2 Please return this form as soon as possible and before June 15th, 2014 for reduced fees together with your registration fee and gala dinner participation in Euro by check or credit card to Menton Tourist Office (see next page for details). Please type or print all requested entries
M. MRS. MISS NAME …………………………………… SURNAME …………….….…….………….. ADDRESS ………………………………...……………………………………………………………………………. ZIP CODE ………….…….... TOWN ………..……………………….. PHONE: + …./.…/…./…./…. /….
FAX: + ..../…./…./…./…./….
ADDRESS OF INVOICE (IF DIFFERENT)
COUNTRY…………………………………...
E-MAIL: ………………………………….……..
FIRM ……………………………………………………………………….
ADDRESS ….. .………………………………...………………………………………………………….…………… ZIP CODE ………….…….... TOWN ………..……………………….. PHONE: + …./.…/…./…./…. /…. DATE: ARRIVAL ….. /….. /…….
FAX: + ..../…./…./…./…./….
HOUR: .….……
E-MAIL: ………………………….……………..
DEPARTURE: …. /…. /……
TRANSPORT:
COUNTRY…………………………………... HOUR: .….……………......
ACCOMMODATION MENTON TOURIST OFFICE WILL SEND YOU A CONFIRMATION OF YOUR REGISTRATION TOGETHER WITH THE WORKSHOP HOTELS LIST AND THE CODE TO GET A DISCOUNT ON PUBLIC RATES FOR THE WORKSHOP ON ITS WEBSITE
SOCIAL PROGRAMME I WISH TO RESERVE:
THE GALA DINNER OF 19TH AT 8:00 PM
NUMBER OF PERSONS: ……
PAYMENT: REGISTRATION FEE + SOCIAL PROGRAMME REGISTRATION FEE PER PERSON INCLUDING VAT 20% BEFORE JUNE 15
TH
, 2014: FROM JUNE 16 TO JULY 31 , 2014: ST ST FROM AUGUST 1 TO 31 , 2014: PRIVATE COMPANIES MEMBER: PRIVATE COMPANIES POSTER BOARD OR TABLE : 1POSTER BOARD + TABLE COMPULSORY GALA DINNER OF 19TH PARTICIPATION IF SELECTED : TH
ST
200 € 250 € 300 € 500 € 2000 € 3000€ 80 € PER PERSON
=……… =……… =……… =……… =…….... =…….... =………
€ € € € € € €
I AM ENCLOSING A PAYMENT CORRESPONDING TO MY REGISTRATION FEE + GALA DINNER IF SELECTED:
TOTAL TO BE PAID:
BY CHECK - PAYABLE TO
BY CREDIT CARD SECURED PAYMENT ON LINE: https://jepaieenligne.systempay.fr/OTVM_BILLETTERIE
OFFICE DE TOURISME DE LA VILLE DE MENTON
=…............... €
(Please, see the how to fill form to get the translation in English) - REFERENCE TO MENTION: LYMPHOMA 2014 CARD: VISA
- MASTERCARD - MAESTRO
NAME ON THE CARD: …………………………………………… DATE: - - \ - -\ - - - -
SIGNATURE (COMPULSORY):
5th INTERNATIONAL WORKSHOP WORKSHOP ON INTERIM PET IN LYMPHOMA September 1919-20, 2014
« PALAIS DE L’EUROPE L’EUROPE » MENTON – FRENCH RIVIERA
ACCOMMODATION and SOCIAL PROGRAMME BOOKING
You will have to be registered in order to receive the workshop hotels list and the code to be able to make a direct booking on Menton Tourist Office website: http://www.tourisme-menton.fr This code will entitle you to a special discount for the nights of September 18th, 19th, 20th, 21st, 2014 We invite you to make an early booking as there is no guaranty on the availability of the rooms IMPORTANT: No registration will be accepted without the following payment: •
200 € (before June 15th, 2014), 250 € (between June 16th to July 31st, 2014 or 300 € from August 1st to 31st, 2014) of registration fee including processing fees, lunch of September 19th and 20th, coffee breaks, one badge.
•
500 € for Private Companies Member registration
•
2000 € for each Poster Board display or table
•
3000 € for 1 Poster Board + 1 Table
•
80 € for the Gala Dinner* at Vista Palace***** on September 19th if requested (coach transfer included). Appointment for the transfer in front of the Palais de l’Europe at 7:30 pm *Within
the limits of available places
Menton Tourist Office will confirm your registration and social programme bookings by sending you an invoice and the corresponding voucher(s)
CANCELLATION CONDITIONS
All cancellation requests must be confirmed in writing to Menton Tourist Office and providing bank details (IBAN and BIC) before August 31th, 2014. No refund after August 31th, 2014. In all cases a 50 € processing fee will be retained by Menton Tourist Office.
BE ATTENTIVE RETURN OF YOUR REGISTRATION FORM AS SOON AS POSSIBLE TO:
DANIELLE LE GOFF - OFFICE DE TOURISME DE MENTON – www.tourisme-menton.fr POLE CONGRES – PALAIS DE L’EUROPE - 8 AVENUE BOYER 06500 MENTON
TEL. : + 33 (0)4 92 41 76 80 - FAX. : +33 (0)4 92 41 76 82 – EMAIL :
[email protected]
