Eurosight pre-registration

You can print this form, complete it and return it to the Conference Secretariat. Don't forget your signature and payment.

You can also fill in the required information, then print it and add your signature.

Note that this form can NOT be used for on-line registration. You have to send it by postal mail. (we need your signature in order to process the payments).

	male female
Title:
Initials:
Family name:
Institute, department or company:
Address:
Postal/ZIP code:
City:
Country:
Telephone:
Telefax:
E-mail:
ISLRR member:

Registration options
(please select one registration option):

1.	Full registration including hotel reservation (single room) for the stay of 3 nights (arrival on Sunday – departure on Wednesday)
	early fee, payment received before 15 June Dfl. 1550 / 703 Euro
	late fee, payment received after 15 June Dfl. 1750 / 794 Euro
	early fee ISLRR-member, payment received before 15 June Dfl. 1500 / 680 Euro
	late fee ISLRR-member, payment received after 15 June Dfl. 1700 / 771 Euro
2.	full registration excluding hotel reservation
	early fee, payment received before 15 June Dfl. 1050 / 476 Euro
	late fee, payment received after 15 June Dfl. 1250 / 567 Euro
	early fee ISLRR-member, payment received before 15 June Dfl. 1000 / 453 Euro
	late fee ISLRR-member, payment received after 15 June Dfl. 1200 / 544 Euro
3.	One day registration
	early fee, payment received before 15 June Dfl. 450 / 204 Euro
	late fee, payment received after 15 June Dfl. 575 / 260 Euro
	early fee ISLRR-member, payment received before 15 June Dfl. 425 / 192 Euro
	late fee ISLRR-member, payment received after 15 June Dfl. 550 / 249 Euro
	Monday, Tuesday, Wednesday (indicate which day)

Social programme (check if appplicable)

	Dinner on Monday 4 September 2000 Dfl. 50 / 22 Euro (included in the full registration fee with hotel reservation)
	Conference dinner on Tuesday 5 September 2000 Dfl. 175 / 79 Euro

Special requirements / other (check if appplicable)

will bring a guide dog

food wishes:

vegetarian

other:

will need a large-printed copy of the programme/abstractbook

Payments (please check payment method; don't forget your signature!)

total indebted payment: Euro

by enclosed certified cheque

by bank transfer

or by credit card: VISA Euro/Mastercard

Credit card number:
Expiry date:
Name of the cardholder:
Address of the cardholder:
Signature of the cardholder:

(Make sure you have enclosed a copy of both sides of your credit card)

By signing this form, you are obliged to fulfil all conditions concerning payment and cancellation (see second announcement).

Date:
Signature:

Return this completed form to:

Conference Secretariat "Eurosight2000"
Van Namen & Westerlaken Congress Organization Services
P.O. Box 1558
6501 BN NIJMEGEN
The Netherlands
Tel. +31 24 323 44 71 / Fax +31 24 360 11 59

e-mail: eurosight2000@congres.net
http://www.eurosight.org

Eurosight 2000

REGISTRATION AND HOTEL RESERVATION FORM