Please fill the form below and press the send
bottom or AIRMAIL to:
The Secretariat
2nd WORLD CONGRESS ON THE AGING MALE
KUONI CONGRESS
54, Rue de Lausanne
CH-1202 Geneva, Switzerland
Tel: +41 22 908 1855;
Fax: +41 22 908 1835;
E-Mail: agingmale@kuoni.ch
You may also download a PDF file with the form.
Participant
Family Name
First Name
Title
Department
Institution
Mailing Address
No.
Street
Suite/Apt.
City
State/Province
Postal Code
Country
Telephone: (office hours)
Country code/city code/number
Fax:
Country code/city code/number
E-Mail:
Name(s) of Accompanying Person(s)
Before November 1,1999
After November 1,1999
Participant
US$580
US$630
Accompanying Person
US$150
US$180
Gala Dinner per person
US$70
Total:
Bank cheques or Eurocheques are acceptable, however personal cheques will
not be accepted.
* Payment by cheque, made payable to the above address:
Cheque No.
Bank
* Payment by bank transfer should be made to:
THE AGING MALE 2000
Credit Suisse Geneva
Bank Account # 4251-380510 -72
* Payment by credit card:
Visa American Express (charged in US$)
MasterCard Eurocard Diners (charged in Swiss Francs with the equivalent US$ rate)
