Registration
11th European Paediatric Neurology Society Congress 2015
Austria Center Vienna, Austria, 27 – 30 May 2015
Please return this form per fax or postal mail before 20 May 2015 to:
Intercongress GmbH, Karlsruher Str. 3, 79108 Freiburg, Germany
fon +49 (0) 761 69699-0 fax +49 (0) 761 69699-11
Please use one form for each participant and fill it in electronically or in block letters!
Participant
Family name
First name
Title
Street
Post code, City
Country
Phone
Fax
E-mail
Invoice address
Institution
Department
1. CONGRESS FEE
EPNS member
Congress ticket
(27 – 30 May 2015)
up to 15 March 2015
Non member
from 16 March 2015
up to 15 March 2015
from 16 March 2015
Physician
575,00 €
680,00 €
785,00 €
890,00 €
Trainee (student or resident)*
300,00 €
375,00 €
300,00 €
375,00 €
Accompanying person
75,00 €
75,00 €
75,00 €
75,00 €
Wednesday
Day ticket
Friday
EPNS
member
Non
member
Thursday
EPNS
member
Non
member
Saturday
EPNS
member
Non
member
Physician
Trainee
(student or resident)*
Nurse, therapist*
230,00 €
300,00 €
180,00 €
235,00 €
100,00 €
135,00 €
230,00 €
300,00 €
180,00 €
235,00 €
100,00 €
135,00 €
45,00 €
45,00 €
45,00 €
45,00 €
45,00 €
45,00 €
Accompanying person
230,00 €
300,00 €
180,00 €
235,00 €
100,00 €
135,00 €
* only with certificate
Satellite Symposium
(25 – 26 May 2015)
Physician
in combination
with congress ticket
75,00 €
75,00 €
Trainee (student or resident)*
single booking
150,00 €
150,00 €
* only with certificate
Participation Satellite Symposium:
Monday, 25 May 2015
Faculty and Delegate Dinner Monday, 25 May 2015; 20:00 h – 22:00 h
Tuesday, 26 May 2015
Faculty and Delegate Reception Tuesday, 26 May 2015; 20:00 h – 22:00 h
Are you happy for us to publicate name, country, profession & email onsite on a delegates list?
Yes
No
Do you have any special needs (e.g. wheelchair, etc.)? If yes, please specify below!
Do you have special dietary requirements? If yes, please specify below!
2. EARLY MORNING SESSIONS
Please note: participation only in combination with congress or day ticket!
Wednesday, 27 May 2015; 07:30 h – 08:15 h
EMS1: Use of new and old EEG methodologies in paediatric neurology practice
0,00 €
EMS2: Handling of the expanded spectrum of treatable intellectual disability
0,00 €
EMS3: Neuroimaging in paediatric bone diseases
0,00 €
Thursday, 28 May 2015; 07:30 h – 08:15 h
EMS4: Epileptic encephlopathies
0,00 €
EMS5: Improving care in outpatient clinics
0,00 €
EMS6: Pattern recognition approach to paediatric cerebellar malformations and degenerations
0,00 €
EMS11: Home-Videosomnography
0,00 €
Friday, 29 May 2015; 07:30 h – 08:15 h
EMS7: Neuroimmunology
0,00 €
EMS8: Electromyography in small infants: techniques and pitfalls
0,00 €
EMS9: Neurofibromatosis type I and II
0,00 €
EMS10: Fetal alcohol spectrum: Clinical spectrum, prognosis, interventions
0,00 €
3. EPNS ACADEMY
Saturday, 30 May 2015; 09:00 h – 10:30 h
EPNS member
0,00 €
Non member
50,00 €
4. LUNCH-SYMPOSIA
Please note: participation only in combination with congress or day ticket!
Wednesday, 27 May 2015
SY01: Natus Medical Inc
0,00 €
SY02: Sarepta Therapeutics
0,00 €
SY03: Biogen Idec
0,00 €
Thursday, 28 May 2015
SY04: Novartis Pharmaceuticals Corporation
0,00 €
SY05: Actelion Pharmaceuticals
0,00 €
SY06: Cyberonics Europe
0,00 €
SY07: PTC
0,00 €
Friday, 29 May 2015; 07:30 h – 08:15 h
SY08: EISAI GesmbH
0,00 €
SY09: Pharm Allergan AG
0,00 €
SY10: BioMarin
0,00 €
SY11: Orphan Europe
0,00 €
5. SOCIAL PROGRAMME
Welcome Reception at Vienna City Hall. Wednesday, 27 May 2015
x participant
per person
0,00 €
Networking Event at "Garden Palais Liechtenstein". Thursday, 28 May 2015
up to 15 March 2015
x participant
75,00 x
€
from 16 March 2015
participant
85,00 €
6. PAYMENT
Payment in advance
 Credit card
VISA
Total (€)
MasterCard
Card no (XXXX XXXX XXXX XXXX)
Valid thru (XX / XX)
CVV (XXX)
 SEPA-Debit note (only possible with German bank account)
IBAN
BIC
The creditor identification number of Intercongress is DE15ZZZ 000 004 457 05.
You will receive your mandate reference with your invoice/confirmation of booking.
7. GENERAL TERMS AND CONDITIONS
Congress participation and social programme bookings will be confirmed in writing by Intercongress GmbH. Deadline is the day of receipt of the application together
with a simultaneous direct debit mandate for the amount due. All bookings are binding. All statements are required in writing. Oral agreements are only binding when
these are confirmed by Intercongress GmbH in writing or via e-mail and without delay. For alterations of reservations or any other invoiced item an administrative
charge of 20,-- € will be charged. A cancellation charge of 30,-- € will be charged for cancellations until 28 April 2015. The fee for congress participation will not be
refunded, even in case of non-participation, if a cancellation is not received in time. A refused visa application is no reason for refund. Alternative participants are
readily accepted for an administrative charge of 20,-- €. Social programmes can only be carried out if a certain minimum number of participants per programme are
reached. Otherwise the programme will have to be cancelled without substitution and the paid amount will be reimbursed completely. No reimbursement will be
made in case of cancellation of a social programme from a participant. In case the event cannot be organised or is subject to change due to reasons which are
outsid e of the sphere of responsibility of Intercongress GmbH (e.g. natural catastrophe, strike or force majeure), no claim for refund of the (proportionate)
registration fees or for a compensation of any (financial) losses can be made. Bank charges for return debit notes are on the participants account. The client agrees
on a settlement of the services via fax or e-mail by Intercongress GmbH. A postal notification only occurs on explicit demand of the customer. The participants are
herewith informed that photos, videos and audio recording of the attendees are being created at the congress. This material will be published on the organiser’s
homepage, in professional journals and/or in other publications after the congress. The participants agree on the usage or release of these recordings with their
signature. Please be advised that the organiser is only liable for claims arising from physical injuries due to intent or negligence of the organiser, or for claims arising
from property damages due to intent or gross negligence of the organiser. Any further claims are excluded. The organiser is not liable for the loss or theft of objects
or motor vehicles brought along, except in cases of intent or grossly negligent causation. This shall not affect further claims against persons and/or companies
charged with the excursions/events related to the congress.The exhibitors are provided with barcode scanners. If the participants agree with the scan of the barcode
printed on their name badge onsite, the exhibiting company receives Name, postal address and e-mail address of the participants for the passing on of information
material. If this is not desired, you need to refuse the scan of your name badge onsite. The place of performance and jurisdiction, as far as permissible by law, is
Freiburg.
Information regarding data protection
Intercongress GmbH is a Professional Congress Organizer. The protection of your privacy as a user of our offers has maximum priority, in particular as to deal with
your personal data.
1.
Use of personal data
Intercongress GmbH uses the data collected during the registration
- to arrange the conference you registered for, if applicable including external service providers,
- to inform you via e-mail or by airmail about other conferences organised by Intercongress, which could be of interest for you.
At anytime you can oppugn the promotional use of your data with effect on the future without incurring any costs other than the transmission costs in
accordance with the basic tariffs. Please refer to: Intercongress GmbH, Wilhelmstraße 7,
65185 Wiesbaden, fon +49 611 97716-0, fax +49 611 97716-16, welcome@intercongress.de
2.
Data transmission to third parties
Intercongress GmbH will not regularely sale or rent your personal data to third parties. Intercongress GmbH passes you personal data to third parties only, if
- this is legal without your agreement,
- the transmission is necessary to arrange the conference you registered,- service providers, which are involved in congress preparation need the data
to render their services
3.
Responsible unit
Intercongress GmbH, Wilhelmstraße 7, 65185 Wiesbaden
Court of registration: Amtsgericht Wiesbaden
Registration number: HRB 8375
USt-ID DE 258 269 762
Managing Director: Diana Kraus
fon +49 611 97716-0
fax +49 611 97716-16
welcome@intercongress.de
www.intercongress.de
I hereby accept the above mentioned General terms and conditions.
Date
Signature (in case the form is filled in by hand)