REGISTRATION FORM: (one participant per form and please copy this form as needed)  Please copy this form and e-mail, fax, or mail the information to ASA AND copy to Spiez Laboratory..

ASA fax: 1-410-638-9481
AND
Irma Lehnherr fax: 41-33-228-1402

ASA e-mail: cbmts@asanltr.com
AND
Irma Lehnherr e-mail: irma.lehnherr@babs.admin.ch

 

CBMTS V
Spiez Laboratory Switzerland

25-30 April 2004
Spiez Switzerland

Use BLOCK letters

Item#    
1 FAMILY NAME:______________________________ FIRST NAME(s):____________________________
2 Title/Profession/Organization: ______________________________ ____________________________________________________
3 Mailing Address:___________________________________________________

___________________________________________________

 City __________________________________________________

Country ___________________________________________________
4 Phone: __________________________________________ Fax: _____________________________________
  E-mail: _________________________________________  
Accommodation Request:
5 Request hotel. Note if reservation is for single (S), double (D), or double with single occupancy (D/SO)
All prices are in Swiss Francs, CHF!!

Hotel _____________________ S_________ D/SO____________ D __________
  Hotel Royal St. Georges (4 star): www.royal-stgeorges.ch
Single room CHF 130 		Double room, single occupancy CHF150
Double room, double occupancy CHF 200
  Hotel Chalet Oberland (3 star): www.chalet-oberland.ch
Double room, single occupancy CHF 110		 Double room, double occupancy CHF 170
  Hotel Harder-Minerva (2 star): www.harder-minerva.ch or www.InterlakenTourism.ch Single room CHF 90
6 Arrival Time: Date& Time to Zurich or Geneva by Airline and flight number or other means
  Departure Time: Date& Time from Zurich or Geneva by Airline and flight number or other means
7 Abstract Submission (by 15 December 2004):  
  Abstract Title: ________________________________________________________________________
  Abstract Authors: _________________________________________________________________________
REGISTRATION FEES:  
8 Individual Registration Fees:
for Individual Members before 25 February 2004 from 25 February 2004
Government /Academia CHF 890 CHF 1080
Industry CHF 1180 CHF 1390
9
Acommpanying Person  
FAMILY NAME:______________________________ FIRST NAME(s):____________________________

Accompanying Persons Fees:

Lunch CHF 16
Dinner CHF 28
Welcome Party CHF 30
Symposium Dinner CHF 90
Excursion and farewell party with dinner CHF 50
10 Terms of Payment:  
  A. Payments are accepted by credit cards Visa, Master Card, EuroCard, Diners Club and American Express. Payment is also accepted via bank transfer or bank check, or by cash at registration if prior approval has been obtained. Refund policy is on the ASA CBMTS website: http://www.asanltr.com/cbmts/cbmts/V/CBMTSV.htm

Amex
 

 

Eurocard
 

 

Visa
 

 

Master Card
 

 

Diners

 

 

  Card Number ____________________________________

Expiration Date ______________________________

Card Member Name ____________________________________

Billing address if different than item #3 ____________________________________

____________________________________
  B. Bank data for CBMTS V Switzerland:

Switzerland
Account No. 42 3.694.965.22
Swift code: KBBECH2237A
Bankclearing No. 79030

 Address:

Berner Kantonalbank,
Filiale Spiez,
Kronenplatz,
CH-3700 Spiez,

 

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Last update: 3 Nov 2003, BBSP