Maastricht Travel and Tropical Medicine Symposium, 29 September 2000
Registration
REGISTRATION FORM
If you are interested in the conference, please complete this form and fax it to
+ 31 (0)43 3566981 or send it to the symposium secretariat:
- I would like to attend the conference, please complete this registration form;
- I would like to receive more information about the conference;
- I would like to receive more information about hotel accommodation;
- I cannot attend this year’s MTTM conference, but please keep me informed about future conferences.
MTTM symposium secretariat
P.O. Box 1462, 6201 BL MAASTRICHT, The Netherlands
Tel.: + 31 (0)43 3566985 - Fax: + 31 (0)43 3566981 - E-mail:
lieben@worldonline.nl
Personal details (please, complete in capitals)
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Registration fee
Participants - Payments received after 1 April 2000 - Euro 199
Students/tropical doctors in training / tropical nurses in training/midwives in training - Euro 65
Method of payment - I would like to pay
by
BANK
Address your bank transfer to: MTTM symposium 2000
Bank: ABN-AMRO, Maastricht NL, Account number: 509400302
PLEASE ATTACH A COPY OF THE TRANFER RECEIPT FROM YOUR BANK
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I authorise MTTM/Lieben Eventives to charge the registration fee for the MTTM Symposium 2000
to my credit card. My credit card details are: |
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