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Registration form
Please forward the completed form to: Please complete by using block letters or typewriter
CPO HANSER SERVICE GmbH Phone: +49 – (0)30 – 300 669 0
Paulsborner Str. 44 Fax: +49 – (0)30 – 300 669 50
14193 Berlin, Germany Email: dgppn09@cpo­hanser.de
A. Participant
❑ Ms ❑ Mrs ❑ Mr ❑ Dr ❑ Prof
Family name: First name:
Mailing address:
Institute:
Department:
Street:
Postal Code, City: Country:
Phone: Fax:
Email:
DGPPN CONGRESS 2009
with DGPPN Academy for Continuing Medical Education
25 – 28 November 2009 // ICC Berlin, Germany
B. Registration Fees (Please mark with a cross)
Registration and Payment received by 14. 09. 2009 // EUR after 14. 09. 2009 // EUR
Member DGPPN, ÖGPP, SGPP [20] ❑ 200,00 [21] ❑ 250,00
New­Member DGPPN since 2009 *** [22] ❑ 0,00 [22] ❑ 0,00
Non­Member [23] ❑ 350,00 [24] ❑ 450,00
Resident Doctor Member DGPPN, ÖGPP, SGPP * [25] ❑ 150,00 [26] ❑ 200,00
Resident Doctor Non­Member * [27] ❑ 250,00 [28] ❑ 300,00
Affi liated health care professionals, social workers,
occupational therapists and physiotherapists*
[29] ❑ 150,00 [29] ❑ 150,00
Student * [30] ❑ 100,00 [30] ❑ 100,00
Day pass ** 25 Nov 2009 [12] ❑ 250,00 [12] ❑ 250,00
26 Nov 2009 [13] ❑ 250,00 [13] ❑ 250,00
27 Nov 2009 [14] ❑ 250,00 [14] ❑ 250,00
28 Nov 2009 [15] ❑ 250,00 [15] ❑ 250,00
* Please forward the certifi cation via mail, email or fax to the congress offi ce CPO HANSER SERVICE GmbH, Paulsborner Str. 44, 14193 Berlin, Germany,
Fax: +49 – (0)30 – 300 669 50, Email: dgppn09@cpo­hanser.de.
** Congress participants who do not give a scientifi c contribution can buy one day pass. All participants at the congress are obliged to pay the congress fees.
Chairperson, speakers and poster presenters are not in any way exempt from the payment of the complete congress fees.
*** For new members of the DGPPN, the registration fee for the annual DGPPN Congress in Berlin is waived in the year of joining the DGPPN if the membership
fee is paid before 1 November 2009. For further information please contact the DGPPN Headquarters.
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(for internal use only)