Registration Form

Registration Form 2013
First name:______________________________________________________
Last name:______________________________________________________
Institution:______________________________________________________
Address:_______________________________________________________
City:___________________________________________________________
Zip code: _______________________________________________________
Country:________________________________________________________
Phone number:___________________________________________________
E-mail address:___________________________________________________

Please indicate if any special requests are needed (vegetarianer, diet, assistance etc.):
_______________________________________________________________

Do you bring a poster to the meeting for presentation?
Yes:___
No: ___

Additional Comments:______________________________________________
_______________________________________________________________
_______________________________________________________________
Email the registration form to:
Ann-Mari Bertelsen
University hospital of Copenhagen
Finsen Center
Department of Hematology 4042
Blegdamsvej 9
2100 Copenhagen
Denmark

Phone: + 45 3545 ¨9650
Mail: ann-mari.berthelsen@regionh.dk

Fares and prices booking until 01.10.2013
1. The registration fee 1500 Dkr includes the meeting, and all meals  from Thursday to Friday.

Please notice:
The meeting will take place at Rigshospitalet in Auditorium 1 and hotel stay is not included in the meeting fee:
Address of the meeting:
Rigshospitalet
Blegdamsvej 9
2100 Copenhagen


Last day of registration and payment is October 20. 2011
Please: Transfere the registration fee and send an e.mail with the registration form at the same point in time.
Following the registration of your payment, you will receive an e-mail confirming the registration to attend the meeting.

Payment to:
Nordea Bank Danmark A/S
Reg. nr: 2149
Swift:NDEADKKK
IBAN:DK28 2000 6269 277 503

It is very important to include the follow information on the payment transfer:

REFERENCE CODE: 981801610 /YOUR NAME

(IF THIS IS NOT INCLUDED, WE CAN NOT SEE IF YOU HAVE TRANSFERREDE THE PAYMENT FOR THE MEETING)