Network of European Forensic Psychiatrists

Network of European Forensic Psychiatrists

THE GHENT GROUP

Budapest, 17-19 September, 2015

Please use CAPITAL letters and send back the fulfilled form to :

CongressLine Kft.

H-1065 Budapest, Révay köz 2.

Phone: (1)429-0146, Fax: (1) 429-0147

Contact: Bea Golovanova, E-mail:

Deadline for registration and payment: 1 July, 2015.

Personal Data
Family Name: / Given Name(s):
Workplace/Institution:
Affiliation: / Title/Degree:
Postal Code: / City:
Street Address:
Phone: / Fax:
E-mail:
Registration fees
Participant / ⃝ EUR 260 / ______person(s)
Accompany/Spouse / ⃝ EUR 110 / ______person(s)

Registration fees include 27% VAT.

Participant registration fee includes:
-participation on scientific programs and excursions
-lunch on Thursday, Friday and Saturday
-coffee breaks during the meeting
-dinner on Thursday and Friday / Accompany/Spouse registration fee includes:
-dinner on Thursday and Friday
-Jewish Sights tour on Friday
Optional tour for Saturday afternoon
Thematical Sightseeing / ⃝ EUR 40 / ______person(s)
Accommodation*
Hotel MEDOSZ, H-1061 Budapest Jókai tér 9 / Hotel Booking
Date of arrival:
Standard Single room / ⃝ EUR 52/night
Standard Twin room (separate beds) / ⃝ EUR 62/night / Date of departure:
Standard Double room / ⃝ EUR 62/night
Superior Single room (8th Floor) / ⃝ EUR 58/night / Number of nights:
Superior Double room (8th Floor) / ⃝ EUR 68/night
Superior Single room with balcony (9th Floor) / ⃝ EUR 60/night / Roommate:
Panorama Single room (10th Floor) / ⃝ EUR 75/night
Panorama Double room (10th Floor) / ⃝ EUR 84/night / Special request:
Panorama Apartman / ⃝ EUR 110/night

*Room rates include breakfast and all taxes.

PAYMENTS

Registration subtotal / EUR / Please let us know what your preferences are:
⃝ I'm a vegetarian.
⃝ Special food needs:______
⃝ I will take part in the dinner on Thursday, 17 Sept., 2015.
⃝ I will take part in the dinner on Friday, 18 Sept., 2015.
Optional program subtotal / EUR
Accommodation subtotal / EUR
TOTAL TO PAY / EUR
For visiting National Forensic Psychiatric Institute(IMEI) please provide the following details:
Date of Birth:
Place of Birth:
Resident address:
Passport/ID number:
Method of Payment
⃝ Bank transfer
The registration, optional tour and hotel cost have to be made to:
Account holder’s name: CongressLine Ltd.
Bank: K&H Bank Zrt. (H-1095 Budapest, Lechner Ödön fasor 9.)
IBAN: HU19 10404027 50504851 52551011
SWIFT code: OKHBHUHB
Please refer “2015/25” event code when transfer.
All charges due to bank transfers have to be paid by the sender.
The name and address of the sender have to be marked clearly on every remittance.
⃝ Credit card
Card type:⃝ VISA ⃝ EC/MC ⃝ AMEX
Card number: ______- ______- ______- ______
Cardholder’s name: ______
Billing address of the Cardholder:______
Expiry date: ______CVC Code* (only VISA and EC/MC) ______
*the last three digits on the back of the credit card where the signature is
Please note that our Agency/Office will debit your credit card in EUR.
Invoice details
Invoice name:
Invoice address:
Reference:

Cancellation terms & conditions of the registration, optional tours and accommodation:

-100% refund (minus 30 EUR administrative fee) in case of cancellation received by 17 August, 2015.

-50% refund in case of cancellation received by 1 September, 2015.

-No refund in case of cancellation after 1 September, 2015.

-If the optional tour is cancelled by the organisers, the full tour fee will be reimbursed.

 I have read and accepted the above terms and conditions.

______

Date Signature