2nd SURGICAL WORKSHOP
of COMPLEX URO-GENITAL
RECONSTRUCTIVE SURGERY IN ADULTHOOD (11-12 September 2009)
APPLICATION FORM
(return by fax or email)
[the MS Word version of this form uses Macros & ActiveX content which must be enabled on your computer to function properly]
PERSONAL DETAILS
Title: / Dr.Mrs.Dr.Prof.
First name: /
Last name: /
Institution: /
Department /
Address: /
City: /
Zip code: /
Country: /
Phone: / -
Fax: / -
E-mail: /
WORKSHOP REGISTRATION
Registration fee includes official dinner, lunches and coffee/tea break.
/ /
Registration / Fee
Participant / EUR 300.00
PAYMENT METHOD
Bank Transfer:
Head Office
Volksbank
Bulevar Mihaila Pupina 165g
11070 Novi Beograd
Serbia & Montenegro
Telephone +381 11 201 69 69
Fax +381 11 201 32 70
Please pay in accordance with the following instructions:
Amount: 300 Euros
SWIFT
field No: / Field description:
59: / Beneficiary: “UDRUZENJE GRADJANA PROFESOR SAVA PEROVIC”
Kadinjaca 21,
Belgrade,
Serbia
IBAN: RS35285005409697000276
57a: / Beneficiary Bank: VOLKSBANK AD
BEOGRAD
S.W.I.F.T. Code: VBOERSBG
56a: / Intermediary: DEUTSCHE BANK AG
FRANKFURT
S.W.I.F.T. Code: DEUTDEFF
VOLKSBANK AD
BEOGRAD
Volksbank a.d. S.W.I.F.T. Code
Maticni broj: 07792247 VBOERSBG www.volksbank.co.yu
VB-SCG-311-018-151105
HOTEL ACCOMODATION – SUGGESTIONS
1. HYATT Hotel***** (~7km from the venue place)
►Address: PO Box 067, Milentija Popovica 5, 11000 Belgrade, Serbia
►Тel.: +381 11 301 1234
►Fax : +381 11 311 2234
►Email:
►Web: http://belgrade.regency.hyatt.com/hyatt/hotels/index.jsp
King Room/ Twin Room ______255 euros / Weekend 205 euros
2. ZIRA Hotel Belgrade**** (~2km from the venue place)
►Address: 35 Ruzveltova Street, 11000 Belgrade, Serbia
►Тel.: + 381 (0) 11 331 48 00
►Fax : + 381 (0) 11 331 48 01
►Email:
►Web: http://www.zirahotels.com/superior_room.html
Superior room______88 euros
Deluxe room______200 euros / Weekend 150 euros
3. Hotel SLAVIJA LUX**** (~4km from the venue place)
► Address: Svetog Save 2, 11000 Belgrade, Serbia
►Tel: +381.11.244 11 20; +381.11.308 48 04; +381.11.308 48 14
►Fax: +381.11.344 29 31
►Web: http://www.slavijahotel.com/indexe.php?act=7
Single room______110 euros / Weekend 85 euros
Double room______145 euros / Weekend 110 euros
4. In Hotel**** (~9km from the venue place)
►Address: Arsenija Carnojevica Blvd. 56, Belgrade, Serbia
►Тel.: +381/11/310-53-55
►Fax : +381/11/310-53-51
►Email:
►Web: http://www.inhotel-belgrade.com/
Single room______CSD 165 euros / Weekend - 90euros
Double room______CSD 185 euros / Weekend –90euros
5. Hotel PARK Belgrade*** (~4km from the venue place)
►Address: Njegoseva 4, 11000 Belgrade, Serbia
►Тel.: + 381 11 / 3640-385; + 381 11 /3640-386
►Fax : + 381 (0) 11 3640393
►Email:
Single room______CSD 70 euros
Double room______CSD 85 euros(renewed 105)
HOTEL RESERVATION
Date of arrival: /
Date of departure: /
Number of accompanying persons: /
Room type: / Single
Double
Please complete this form and send it back by email or fax.
Director: Sava Perovic
Serbian Academy of Sciences and Arts
School of Medicine – University of Belgrade
Tirsova 10
Coordinator: Rados Djinovic, MD
“Sava Perovic Foundation”
Borisavljeviceva 58
11000 Belgrade, Serbia
Fax: +381 112474918
Phone: +381 64 190 3736
E-mail: