Irish College of Ophthalmologists

Annual Conference 2011

Radisson Farnham Estate Cavan,

Thursday 12th to Saturday 14th May, 2011

REGISTRATION FORM

Personal Details

Name
Address
Telephone
Email

Schedule of Conference Fees

Category / Early Fee (before April 22nd) / Late Fee(after April 22nd)
ICO Members / €400 / €450
Non ICO Members / €600 / €650
ICO Affiliates(includes non ICO registered trainees) / €360 (includes annual membership fee) / €400 (includes annual membership fee)
ICO Trainees (BST &
Registrars) / €100 / €150

* There is no Registration fee for retired ICO members

* The Conference fee includes the social event in Lough Rynn Castle on Thursday evening and the Conference gala dinner on Friday evening

Social Events

Golf □
A golf event will be held on the afternoon of Thursday 12th May. Please indicate if you would like to participate;
Dinner Ticket □
Additional Tickets are available for the gala dinner. Please indicate if you would like an additional ticket

Accommodation Package

Single/Double / Price
€85/ night B&B Single
€110/night B&B double / No. of Nights required / Arrival Date / Total

Rooms have been reserved at the Radisson Farnham Estate and are being offered on a bed & breakfast basis, for single or double occupancy. Rate covers full use of health spa facilities

Total Amount Due

Registration Fee; ______
Accommodation; ______
ICO Annual Membership*; ______
Total; ______
* Members must have paid the annual subscription fee to participate in the Annual general meeting

Payment Methods

Payment by cheque or credit/debit card;
Please make cheques payable to the Irish College of Ophthalmologists
Credit Card: Visa □Mastercard □
Credit Card Number: ______/______/______/______
Expiry Date: ______/______
Security Code:______last three digits on the back of your card
Signature:______
Date:______

Please Return before Friday, 15th April 2011 to

Annual Conference

Irish College of Ophthalmologists

121 St. Stephens Green

Dublin 2

Tel: + 353 1 402 2777 Fax: + 353 1 402 2778