3rd International Congress on Coronary Artery Disease -Accommodation Form

Posters Sessions:

General
Information

Pre and Post Congress Tours

Registered Accompanying Persons Program

Accommodation

Accommodation and Tour Form

Registration Form

ACCOMMODATION AND TOUR FORM

Please complete and return this form, together with your payment to:
Kenes International
17 Rue du Cendrier , P.O. Box 1726, CH-1211, Geneva, Switzerland
Tel: +41 22 908 0488;
Fax: +41 22 732 2850;
E-Mail: kenesinternational@kenes.com
Identification
Please complete this section accurately; the information you provide will allow us to correspond with you efficiently, and will also be used on your delegate badge at the Congress.
(Please TYPE or PRINT IN BLOCK LETTERS)

Field marked in red are required.

Participant
Family Name
First Name
Middle Initial(s)
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:
Accommodation
Type of room required Single Double Other
First Choice
Second Choice
Check in date
Check out date
Total night(s)
*I will share my accommodation with

Pre and Post Congress Tours
	Rate	No. of People	Type Of Room
A. AIX LES BAINS ANNECY CHAMONIX Sept. 30 - Oct. 1	Per person in a Double EURO 348.- Single Supplement EURO 27.-		Single Double
B. THE BEAUJOLAIS Oct. 6	EURO 84.-
C. DOMBES AND PEROUGES Oct, 7	EURO 93.-

Hotel Deposit All requests for accommodation must be accompanied by the required deposit of EURO 200 Payment may be made in the following ways:
Method of Payment Option 1: Credit Card - Payments will be charged in US$
Visa MasterCard Diners
Name (as shown on card):
Number:
Expiration Date (month/year):
Option 2 - Bank Transfer - with your name and address indicated on the reverse. If payment is made for more than one person or by a company, please make sure all names are indicated and return fully completed Accommodation form together with a copy of the bank transfer to the Secretariat. Please make drafts payable to: "3rd International Congress on Coronary Artery Disease" and send to: Bank Leumi Le'Israel, Gan Ha'ir Branch, Tel-Aviv, Israel, Account Number PATAM 654-56143/71. Bank charges are the responsibility of the payee. Please specify - FOR ACCOMMODATION Option 3 - Cheque made payable to: 3rd International Congress on Coronary Artery Disease Enclosed cheque number:______________________ Bank:______________________ Please include fully completed registration form. Cancellation Policy Refund of Registration Fees will be made as follows: Post-marked prior to August 10, 2000 - refund less 25%. After this date, no refund can be made.

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