Adress

Registration form should be sent to the following Organizing Office address:
Biuro Kongresów SKOLAMED
PAIZ Konsulting Sp. z o.o.
20-070 Lublin, ul. Boczna Lubomelskiej 4
fax. +48 81 534 71 50
ph. +48 81 534 71 48, +48 81 534 43 87
e-mail: [email protected]
Personal data
Last name ____________________________________ First name ________________________
Adress
Affiliation (optional) ___________________________________________________________________________________________
Street and apartment no._____________________________________________________
Postal code __________
Scientific Degree __________
Town _______________________
Phone ______________________________________________________ Fax ______________________ E-mail _______________________________
1. REGISTRATION FOR THE EDS POSTGRADUATE COURSE
Please choose the appropriate participation fee:
Participant registration fee
before August 31, 2011
after September 1, 2011
50,00 EUR (200,00 PLN)
80,00 EUR (320,00 PLN)
EDS member registration fee
30,00 EUR (120,00 PLN)
TOTAL:
2. PAYMENT
Fee payment should be made within 7 days from sending the form to the Organizing Office bank account.
For payment in EUR (euro):
account name: PAIZ Konsulting Sp. z o.o.
bank: Deutsche Bank PBC SA Branch in Lublin, SWIFT: DEUTPLPK
account number: PL 21 1910 1048 2305 0063 2357 0012
For payment in PLN (polish zloty):
właściciel konta: PAIZ Konsulting Sp. z o.o.
bank: Deutsche Bank PBC SA Oddział w Lublinie
numer konta: 16 1910 1048 2305 0063 2357 0005
Please issue an invoice for:
Buyer :
_________________________________________________________________________________________________________________
Street address:
_________________________________________
Postal code: __________
Invoice will be send by e-mail after receiving the payment.
I accept the terms and conditions and I agree to have my personal data processed by
PAIZ Konsulting Sp. z o.o., 4 Boczna Lubomelskiej Street, 20-070 Lublin, Poland and
Organising Committee (Organiser) for the needs of this course. Regulated by the Polish
law regarding personal data protection.
NIP/Tax number: _____________________
Town: _____________________
.............................................................................
Participant signature
3. TERMS AND CONDITIONS
The confirmation of participation will be sent by e-mail after the payment appears on the Organizing Office account. All changes and cancellations should by
submitted to the Organizing Office - Biuro Kongresów SKOLAMED which is a department of the company PAIZ Konsulting Sp. z o.o., 20-070 Lublin, ul.
Boczna Lubomelskiej 4. Organizer must be notified in writing about all changes and cancellations. The notice should contain the account number for the
reimbursement. The registration fee can be transferred to another participant after the Organizing Office written consent.
In case of cancellation of the registration before August 31, 2011 – the registration fee will be reimbursed. Please take notice that the cost of money transfer will
be deducted (25 EUR for the bank transfer abroad); after September 1, 2011 – no reimbursement is applicable.