REGISTRATION FORM

LUPUS EUROPE CONVENTION – VIENNA 2015

Friday, September 4th - 18:00 to Sunday, September 6th 16:00

MEMBER ORGANISATION NAME:

hereby registers for the LUPUS EUROPE VIENNA 2015 CONVENTION at Leonardo Hotel, Matrosengasse 6-8, 1060 Vienna:

Name / Surname
Email / Phone
Street / Nr
Zipcode/City / Country
Arrival date/(flight/train) / Depart. date (flight/train)
Special needs (dietary, accomm, other)
Participant 2:
Name / Surname
Email / Phone
Street / Nr
Zipcode/City / Country
Arrival date/(flight) / Depart. date (flight)
Special needs (dietary, accomm, other)
Participant 3:
Name / Surname
Email / Phone
Street / Nr
Zipcode/City / Country
Arrival date/(flight) / Depart. date (flight)
Special needs (dietary, accomm, other)

Our organization registers before June 9 and wishes to apply for financial support in the form of:

¨  Convention subsidy of 125 € per person (min. 2 attendants)

¨  Travel grant of up to 250 € per person (max 2 people)

¨  ICL registration subsidy

We hereby confirm that:

¨  Our organization is up-do-date with LUPUS EUROPE membership fees,

¨  Participants commit to actively participate in the entire convention, from dinner on Friday evening until the end of the convention Sunday at 16:00,

Costs and Fee calculation:

Item / Number / Unit price / Total
Convention Registration / 250
ICL attendance fee / 50
Extra Night Sept 2-3 – Single (*) / 99
Extra Night Sept 2-3 – Double (*) / 109
Extra Night Sept 3-4 – Single (*) / 99
Extra Night Sept 3-4 – Double (*) / 109
Convention Sept 4 to 6 – Single / Incl.
Convention Sept 4 to 6 – Double / Incl.
Extra Night Sept 6-7 – Single (*) / 99
Extra Night Sept 6-7 – Double (*) / 109
Sponsorship of ICL attendance fee / -50
Convention Grant (see above) / -125
TOTAL PARTICIPATION COST / - / -

(*) Subject to availability – first come, first served. Don’t wait!

Please e-mail your registration to . Upon receipt, we will send you the confirmed payment total and the bank details so that you can effect your payment. Please note that your confirmation will only be considered final after we have received your payment. Final date for registration and payment will be August 1st.

Page 2 of 2