Hoechst Marion Roussel

Hoechst Marion Roussel

2016 PMG MEETING

26-28 FEBRUARY 2016 AT MOUNT GRACE

MAGALIESBERG

DELEGATESURNAME: FIRST NAME:

TITLE:DR MRMRS MS

E-MAIL:

Name on ID/Driver’s License:

CELL:ID NUMBER:

FAX NUMBER:HPCSA Number :

DELEGATE DIETARY REQUIREMENTS – Please √

Halaal Friendly / Only Vegetarian, Fish and Chicken
Strict Halaal / No Pork
Vegetarian / No Shellfish
Kosher / Other

REGION – Please √

BLOEM / CT / EL / GAUTENG / KZN / GEORGE / NELSPRUIT / PE

FLIGHT DETAILS(If applicable

Arrival Date / 26 FEBRUARY / Flight Arrival Time JHB
Departure Date / 28 FEBRUARY / Flight Departure Time JHB

*Due to the scientific and educational nature of this event, this invitation is not extended to spouses or other accompanying persons*

CONTACT PERSON IN CASE OF EMERGENCY

SURNAME: FIRST NAME:

RELATION:TEL / CELL

ALLERGIES : ______SPECIAL REQUESTS : ______

YES I AM ABLE TO ATTEND / REGRET, I AM UNABLE TO ATTEND

I, the undersigned, accept both the invitation to attend the above event, and have read the terms and conditions attached.

…………………………………….……………………….

SignatureDate

PLEASE EMAIL FORM BACK TO

Terms and Conditions

  1. This invitation is extended to the invitee only, and is therefore NOT transferable to any nominee of the invited delegate.
  1. Zenzela will be responsible for travel, accommodation, meals and congress arrangements for the invited delegate.
  1. Zenzela / PMG will supply one Price Saver priced economy air ticket to and from the event, using an airline, and routing deemed appropriate to PMG. Any costs incurred for flight or airline changes, requested by the delegate, will be for the delegate’s own account.

PMG will be responsible for the single-room accommodation costs and arrangements for the invited delegate only, for the duration of attendance at the above congress and any periods adjacent thereto (as determined by flight scheduling. All PMG Delegates are liable for spouse costs (both HCP and NON HCP). Only PMG members benefit from sponsorship.

  1. The invited delegate shall be responsible for any personal costs incurred incidentally whilst in transit or at the site of the event, such as:
  • Telephone calls
  • Hotel incidentals such as laundry, dry cleaning, in-room courtesy bars, room service and other services charged to the delegate’s room.
  • Any personal transportation, accommodation costs, and arrangements, to and from, or at the site of the event, such as taxicabs, and or public transport.
  • Any personal entertainment expense incurred by the delegate, such as personal meals.
  1. Delegates that cancel will be expected to pay their airfare costs in full if the ticket has been issued.
  1. For non-attendance, there will be a R3000 no show payment to cover accommodation, conferencing fees, and meals costs.
  1. Credit card details must be supplied upon registration and will be debited upon non-attendance.
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