5TH EEMCPDM
REGISTRATION & RESERVATION FORM May 26-29, 2010
I- IDENTIFICATION
Family Name
First Name
Specialty
Hospital or Institute
Address
Country
City
Fax
Phone
Postal Code
E-mail
ACCOMPANYING PERSON (S):
II- REGISTRATION
NB
Type
Amount
Nb of Persons
Total
1
Non Lebanese
275 US $
2
Lebanese
67 US $
3
REGISTRATION for STUDENTS & RESIDENTS FREE
•
Fees for Non Lebanese & Lebanese:
Congress bags, all scientific sessions, lunches and coffee breaks, welcome reception, exhibition entrance ….
•
Fees for Residents & Students:
Access to all scientific sessions, coffee breaks, welcome reception, exhibition entrance (does not include lunch)
III -
GALA DINNER: 75 US$
Nb of Persons
Total
IV- ACCOMMODATION
Date of Arrival:
Time:
Flight #:
Date of Departure:
Time:
Flight #:
Transfer with Meet & Assist and drop off:
30 US $ / per person
nbr of persons
Total
HOTEL
Location & Category
Room Type
Rate SGL
No of Nights
RATE DBL/TWN
No of Nights
Total
Movenpick
(Congress venue)
5*A
Deluxe City View
$ 230
$ 265
Deluxe Court Rooms
$ 210
$ 242
Safir Heliopolitan
5 *B
Deluxe
$ 121
$ 246
Lancaster
4*
Classics
$ 105
$ 116
Duroy
4*
Classic
$ 77
$ 94
* Rates are all taxes included
V- Site Seeing Tour
Day
Destination
Price
Nb of persons
Total
Thursday May 27
Jeita GROTTO
40 US $/ per person
Saturday May 29
Beiteddine
70 US $/ per person
Jeita Grotto Tour includes transportation, entrance fees.
Beitteddine site seeing tour includes, transportation, all entrance fees & Lunch.
Grand Total: II + III + IV + V =
BANK TRANSFER
Infomed International for Events
BankMed
Bourj Hammoud Branch
Account number:0240018889300
Chips UID: CH 035040
Swift Code: MEDLLBBX
CREDIT CARD
Master Card
Visa Card
Card No
Card holder name
Exp. Date
Security Code (3-4 digits to the right of the signature strip)
Comments or Recommendations
Infomed
International for Events © 2009
