Registro WCEF 2007

REGISTRATION FORM

First name*

Last name *

E-mail *

Degree

Address

City *

Zip Code *

Country *

Telephone *

Fax *

Institution

REGISTRATIONS FEE *

Registration Fee	EARLY July 15/06 - October 15/06	REGULAR October 16/06 - April 30/07	LATE May 01/07 - August 31/07	ON SITE
Doctors	300	450	550	650
EOA Members*	200	300	350	400
Accompanying Person	250	250	250	300

All the fees are in USD $ (United State Dollar)
*These fees do not include Gala Dinner

CONGRESS COURSES

Pre Congress Course
Bone Defect, Infection, Non Union and Intra-articular Fracture Management Date: Tuesday, 16/10/2007 Faculties: Maurizio Catagni, MD Mehmet Kocaoglu, MD Kevin Tetsworth, MD Mahmoud Fayed, MD	150.00
Post Congress Course
Deformity Management Date: Saturday, 20/10/2007 – Sunday, 21/10/2007 Faculties: Dror Paley, MD John Herzenberg, MD Yasser Elbatrawy, MD	300.00

All the fees are in USD $ (United State Dollar)

Amount to be paid in US$

Total Fee In Letters *

PAYMENT TERMS

Please debit my credit card

Visa Master Card American Express

Card Number *

Expiration Date * ( mm/yyyy)

Master Card Security Code

For all Master Card cards, please enclosed a copy of credit card and identity document or passport copy. It must be send to registration@cycevents.com or send by fax to +511 2340122

Bank *

Card Holder *

By this mean, I authorize C&C International Events S.A. to make the debit from my credit card for the inscription to this Congress:

Comments

Complete this form, submit it and print a copy for your records:
Secretariat of the Congress: C&C International Events S.A.
Phone: +511 242 – 5025 / Fax: +511 234 - 0122
E-mail: registration@cycevents.com

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