The 17th conference (5th International) of the Medical Research Institute

 

Advances in Medical Research

-OBESITY-

 

November 13th-16th, 2012

Alexandria - Egypt

  foreigners  REGISTRATION  FORM 

Please fill in all fields marked with a *

PARTICIPANT’S DETAILS

Title Prof   Dr    Mrs  Ms   Mr   *
First Name *
Middle Initials *
Family Name *
Nationality *
Passport Number *
Professional Activity Clinician    Researcher   Scientific officer technologist    Physiotherapist   Nurse   *
Company Organization *
Mailing Address *
Postal Code
City *
Telephone
Facsimile
E mail *

Registration Fees

All  fees are quoted in American Dollars .

Registration includes participation in the scientific program , conference kit , and coffee breaks  ( Scientific ) , in addition to three lunches ( Full ) .

 

Before 31st August After 31st August
Scientific US$ 250 US$ 350
Full US$ 550 US$ 700

 

 Please specify your choice for the registration
Registration Scientific  Full
Accompanying persons are exempted from the registration fees and in case of full registration for the active participant,  an amount of $ 50. is requested for the accompanying person covering 3 lunches .
I request 3 lunches for my accompanying person

 Accommodation

An attractive rate has been obtained from 5 star hotel

Deadline for hotel reservations 31th of August , 2012

An exhibition of the latest technical equipment, diagnostic and pharmaceutical products will be held at the exhibition area.                                                                
(Reservation is required) .  
Accommodation Booking I require accommodation  I do not require accommodation
Date of arrival
Date of Departure
Room Type Single Room    Double room
No of nights
No of rooms
No of Accompanying person s
Person 1 First Name
Person 1 Last Name
Person 1 Passport No
Person 2 First Name
Person 2 Last Name
Person 2 Passport No

SOCIAL  ACTIVITIES

A- Gala Dinner 
B- Site Seeing Tour                (Reservation is required)

Gala Dinner No of tickets required

Cancellation and REFUND Terms

Registration fees

The secretariat must be notified of all cancellations in writing. Refund will be made within 4 weeks following conclusion of the meeting
Cancellation until 15th of August, 2012  :  Full refund
Cancellation until 15th of september, 2012: Refund amount 50%
Cancellation after 15th of september, 2012 : No refund

Accommodation

Hotel deposits will be refunded, less 10 % administrative fee, provided a written cancellation is received by  September 30th , 2012. After this date , hotel deposits will not be refunded .

Social

No refunds will be made after September 30th , 2012 .
I agree with the cancellation and refund terms *

METHODS OF PAYMENT

By bank transfer  

Bank :The National Bank of Egypt– Alexandria University Branch
Address :Al-Iskander Al-Akbar Street , Chatby 21511 - Alexandria – Egypt
Swift code :NBEGEGCX207          Account No. : 0101500207/3

After Payment , Pleas Send Us The Receipt Of Bank Deposition

( BY Email Or Fax )