Registration
Please complete this form and return
to our registration office
byfax: +43/6432/3393271
by email:
or mail to:
International Forum GasteinA2
Tauernplatz 1
5630 Bad Hofgastein
Austria
□ I will participate in the European Health Forum Gastein 2010 and will attend the following forum sessions:
Group 1:Wednesday, October 6th, 15:30 – 18:30
Thursday, October 7th, 9:00 – 12:00
□ F1 Healthy Ageing
□ F2Adult respiratory diseases
□ F3 EU action and local partnerships
Group2:Thursday, October 7th, 14:30 – 17:30
Friday, October 8th, 9:00 – 12:00
□ F4 Health literacy
□ F5 Health is global
□ F6a Personalized medicine, October 7th 14:30 – 17:30
□ F6b Health workforce, October 8th 9:00 – 12:00
Please send me Information on Supporting Membership □ yes□ no
How did you learn about the European Health Forum Gastein? ______
My (our) correct registration address is:
□ Mr. □ Ms. □ Prof. □ Dr. First name: ______Surname: ______
position/department: ______
institution/organisation/company: ______
street (P.O.B): ______
postcode/city/country: ______
telephone: ______/ ______/ ______fax: ______/ ______/ ______
e-mail: ______Internet address: ______
I agree to the storage of my personal data on electronic media and inclusion of my name in the official list of delegates, which will be published. The address data may be forwarded to other participants and members of the IFG / EHFG. (please delete if not applicable).
Accompanying person not participating in the congress:
□ Mr. □ Mrs. □ Prof. □ Dr. First name: ______Surname: ______
Hotel reservation:Number of rooms: ___ single rooms___ double rooms
Category:□ *****□ ****deluxe□ ****□ ***
164 Euro 139 Euro 112 Euro86 Euro
(prices per person and per day, half board and 10% VAT included. Accompanying persons (not participating) staying in the same room will pay 60 % of the regular hotel rates.)
Arrival date:___ / __/ 2010Departure date:___ / __ / 2010
Applicable congress fee (please mark):
Late booking (until 8thOctober 2010)Standard fee / □ 1750,- Euro (incl. 20% VAT)
“Reduced fee” (a contribution towards costs available only to representatives of consumer/patient organisations and full-time staff of universities) / □ 480,- Euro (incl. 20% VAT)
□ The reduction for Supporting Members of EHFG is applicable to this registration.
Payment:I will pay by □ credit card / □ bank transfer.
Bank transfer: Account holder: International Forum Gastein; Bank office: Salzburger Sparkasse Bad Hofgastein, International Account No IBAN AT 15 2040400200222240. BIC Code: SBGSAT2S ; Please report the following information on it: “EHFG-Participation”, name of participant, organisation.
Credit card: □ Visa □ Eurocard/Mastercard □ American Express □ Diners Club, Card No. Expiry Date
No other credit cards can be accepted. All fees paid by credit card will be charged at the fixed or actual exchange rate. I entitle the International Forum Gastein to debit or credit my credit card account with the amount of any subsequent change(s) to the items registered for.
Participation can only be guaranteed if payment was made prior to the beginning of the EHFG 2010
Date, signature: ______
Includedin the Congress fee and the hotel reservation are the registration fee, participation in all events around the EHFG, break refreshments, Lunch & Dinner Sessions, congress papers delivered to your hotel, the Congress Report, shuttle service from/to Salzburg Airport or Schwarzach-St. Veit / Bad Gastein railway stations, social events for all participants and partners. Congress fee only includes registration fee, participation in all main EHFG sessions (plenary, parallel forum sessions and workshops, excluding lunch and dinner workshop) refreshments during breaks, congress papers, and congress report. You are invoiced after receiving your signed individual Registration form. The invoice is your confirmation. Cancellation must be notified in writing. Cancellation fee is 10% of the total amount due until 10 September 2010, 50% thereafter. The number of rooms in certain categories is limited. Therefore, we ask for your understanding should we be unable to reserve the desired hotel category. This information is subject to change!