EUROPEAN PSYCHO-ANALYTICAL FEDERATION

FÉDÉRATION EUROPÉENNE DE PSYCHANALYSE

EUROPÄISCHE PSYCHOANALYTISCHE FÖDERATION

Association (Verein), art. 60 Swiss Civil Code

Tri Regional Clinical Conference (EPF – FEPAL – NAPsaC)

Relais de Margaux (France), July 19 – 22, 2012

REGISTRATION FORM

Please register with Congress-Organisation Geber+Reusch ()

and copy Eva Schmid-Gloor ()

North American registrants please register with Congress-Organisation Geber+Reusch

() and copy Ed Nersessian ()

Name of participant
First name of participant
Address
Telephone □ privat □ business
Email – will be used to distribute information - please print
Institute/Society
Registration fee includes:
Welcome drink, coffee breaks, breakfast, lunch buffets, Gala Dinner with wine and water/coffee on Saturday and Farewell drink as well as accommodation in a single room for the nights July 19 – 22, 2012 / □ € 950,00 x pers. = €
Supplement for 2nd person sharing a double room for the nights July 19 – 22, 2012 includes: Welcome drink, breakfast, lunch buffets, Gala Dinner with wine and water/coffee on Saturday and Farewell drink. / □ € 350,00 x pers. = €
Please use one form per participant!
Hotel reservation (binding):
Date of Arrival: July 19, 2012 / Date of Departure: July 22, 2012
Relais de Margaux
5, route de l’Ile Vincent – BP 9
F-33 460 Margaux
France / □ Single room July 19-22 incl. in registration fee
□ Double room July 19-22 incl. in reg. fee/supplement
Additional nights: rates per night, per room, incl.breakfast
□ Single room € 180,--- dates ……………………………………
□ Double room € 198,-- dates …………………………………..
Payment by Credit card
(only Master or VISA ) / Number, expiry date, security code:
Cancellation costs / Less than 8 working days prior to arrival date:100%
Between 8-15 days prior to arrival date: 75%
30 working days prior to arrival date: 30%
More than 30 working days prior to arrival date: 5%
No show: 100%