26
th
European Congress of Pathology
30 August – 3 September 2014 · ExCeL London, UK
e
REGISTRATION FORM
e
CONGRESS
Please forward the completed form to:
Please complete using block letters or typewriter
CPO HANSER SERVICE GmbH
Phone: +49–30–300 669 0
PO Box 33 03 16
Fax: +49–30–305 73 91
14173 Berlin, Germany
E-mail:
A
Personal details
❑
Ms
❑
Mrs
❑
Mr
❑
Dr
❑
Prof
964
Family name:
First name:
Institution /Department:
Mailing address:
❑
private address
❑
institute address
Street:
Postal code, City:
Country:
Phone:
Fax:
E-mail:
B
Accompanying Person
❑
Ms
❑
Mrs
❑
Mr
❑
Dr
❑
Prof
964
Family name:
First name:
For registered accompanying persons a
Sightseeing Tour
is included.
Please indicate if you would like to participate on:
❑
31 Aug 2014
[50]
//
❑
1 Sept 2014
[51]
//
❑
3 Sept 2014
[52]
C
Registration Fees (EUR)
Registration and
Payment received
by 1 April 2014
EUR
by 1 July 2014
EUR
after 1 July 2014
EUR
EUR
ESP Member /Member of
Pathological Society*
❑
[20]
420,00
❑
[21]
530,00
❑
[22]
640,00
Non-Member
❑
[23]
580,00
❑
[24]
680,00
❑
[25]
790,00
Resident **
❑
[26]
180,00
❑
[27]
240,00
❑
[28]
350,00
Accompanying person
a
of an ESP Member/
Member of Pathological
Society
a
of a Non-Member
❑
[29]
60,00
❑
[30]
80,00
❑
[29]
60,00
❑
[30]
80,00
❑
[29]
80,00
❑
[30]
80,00
* In good standing (membership fee for 2014 paid)
** Residents must submit a formal declaration from the Head of Department or the responsible for the training programme to the congress office
(e-mail and fax see below).
Path Society Concessionary members (Trainees, PhD students, Postdoctoral fellows, Biomedical scientists, Technicians, Honorary & Senior members)
also qualify for the resident fee.
Social Programme
Number
of persons
EUR
EUR
Congress Concert
Member (cost contribution)
on 1 September 2014
Non-Member (cost contribution)
[42]
10,00
[43]
20,00
Congress Party
Member (cost contribution)
on 3 September 2014
Non-Member (cost contribution)
[44]
10,00
[45]
50,00
Subtotal
C
for internal use only
for internal use only
23
