AO Trauma Master seminar Intramedullary Nailing Patras , 08-09 November 2013 REGISTRATION FORM Please fill out this form in CAPITAL LETTERS and send it to the secretariat, NIKAIA TRAVEL, by FAX 2104250078 or e-mail email@example.com TITLE: □Prof. □Cons. □Reg. □Dr. □Res. FIRST NAME: □Male □Female LAST NAME: SPECIALTY: HOSPITAL / INSTITUTION: DEPT: CITY: ZIP: TEL: COUNTRY: FAX: E-MAIL: REGISTRATION FEES 180 € Registration fees to the course PAYMENT & CANCELLATION POLICY Payment can be done by A) bank transfer to NATIONAL BANK OF GREECE, Account Number 12644070083 (Beneficiary: Maggoudis Panagiotis & Co.) IBAN GR GR52 0110 1260 0000 1264 4070 083 or by B) Credit card (VISA, MASTER): Please fill out the following: CC Number: _____ _____ _____ _____ _____ Expiry Date: __ / __ CCV: _xxx_ CC Owner’s Name:______________________________________ Amount: ____________€ An official receipt will be issued and sent to you by mail. For hotel accommodation, two nights deposit is necessary, in order to proceed to firm bookings. Payment of all services should be settled by September 25th 2013. Cancellations should be sent to the seminar secretariat in written. Cancellation fees 50% apply until 20 days before the event. No refund will be given after this date.