REGISTRATION FORM: (one participant per form and please copy this form as needed)  Please fax, mail or e-mail this form.

CBMTS IV

Spiez Laboratory

28 April - 3 May 2002, Spiez, Switzerland

Use BLOCK letters

FAMILY NAME:______________________________

FIRST NAME(s):____________________________

Title/Profession/Organization: ________________________________________________________________________________

______________________________________________________________________________________

Best Mailing Address:______________________________________________________________________________________

______________________________________________________________________________________

E-mail: _________________________________________

Fax: _____________________________________

Phone: __________________________________________

Additional e-mail:_________________________

Accommodation Request: Reservation confirmed upon receipt of Registration payment either by credit card, check or electronic funds transfer. No hotel deposit required; however, one night hotel charge will be assessed if cancellation not received by 1600 hours of the previous day to reserved date.

Select hotel. Note if reservation is for single (S), double (D), or double with single occupancy (D/SO)

See prices on CBMTS IV information page.

a. Hotel BelvÈdËre________

b. Hotel Eden ___________

c. Hotel Bellevue ___________ or

d. Spiez Laboratory Dormitory ________ (note dormitory room priority as spelled out in _______)

 

Arrival Time Zurich or Geneva, Aircraft flight number/other means: _________________________________

Departure Time: Zurich or Geneva by aircraft flight number or other: ________________________________

Abstract Submission: has been sent or will be sent by date: _______________________________________

Abstract Title: ____________________________________________________________________________

Abstract Authors: _________________________________________________________________________

REGISTRATION FEES: (all fees in Swiss Francs/on 12 Sept 2001, 1US$ = 1.67 SwissFrancs (SF))

a. Individual Registration Fees:                                                   SFr _______

b. Accompanying Persons Fees                                                  SFr _______

• stay in Dorm to include all meals/Welcome Party/Symposium Dinner = SFr 440
• stay in Dorm to include breakfast/Welcome Party/Symposium Dinner (not lunch/dinner) = SFr 300

Individual fees for meals and other activities for Accompanying Person SFr _______

 

Dormitory room and breakfast	SFr 28 extra/day
Lunch	SFr 17 per day
Dinner	SFr 18 per day
Welcome Party	SFr 28
Symposium Dinner	SFr 83

Terms of Payment: All payments are to be made in SFr by check, credit card or electronic transfer.

By Credit card in amount of SFr _____________

Credit Card number: _______________________ _________ Expiry date:_____

 

___ American Express ___ Master Card ___ Visa ___ Diners

 

 

Cardholder Signature ________________________________________________

 

Date: _______________ Signature: ____________________________________

 

 Information for bank transfer and checks will be supplied by 15 November, 2001.

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Last update: 12 September 2001