Prague Congress Inscription

PRAGUE, September 6- 9, 2008

Last Name :

First Name :

Address :

Zip Code - City

Country :

Phone :

Email :

	Before April 1st	April 1st - July 15th	After July 15th
EVRS Member	320 Euros	420 Euros	520 Euros
EVRS Fellow-in-Training Member	220 Euros	300 Euros	380 Euros

Non EVRS Member	490 Euros	590 Euros	690 Euros
Non EVRS Fellow-in-Training Member	340 Euros	425 Euros	510 Euros
	Reset
Spouse/Guest additional prices :
Including Welcome Reception &	230 Euros
Gala Dinner at the Zofin Palace	40 Euros

		TOTAL	€

Payment Options :

- Credit card: please click on the Online Payment box

- Cheque for the order of EVRS, 8 Rue Camille Flammarion, 44000 Nantes, FRANCE, together with this printed congress registration form.
- Bank transfer. Click here for bank details but please print and fax back this form to + 33 2 51 83 32 61 and write "bank transfer" on it so that we can register you prior to receive your bank transfer.

Cancellation / Refund Policy:

All cancellations and request for refunds must be in writing and received by EVRS no later than August 1st, 2008. A handling fee of 25% of the paid amount will be charged for cancellations in all registration categories. No refunds will be given after August 1st, 2008.