Registration Form SAFE Mentor Training 2013 - PD Karl Heinz Brisch

KLINIKUM DER UNIVERSITÄT MÜNCHEN SEITE 2 VON 3
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Training venue: Kolpinghaus, Adolf-Kolping-Str.1, 80336 Munich.
Registration fee for the entire training block: € 520,-
Responsible person for registration: Claudia Di Muro, phone no. +49-89-
5160 3545, email: claudia.muro@med.uni-muenchen.de
Binding Registration:
The SAFE® Mentor Training can only be booked as a complete block, and
the registration fee is due for payment immediately upon registration, by
bank transfer of 520,- Euro.
I am aware that with my signature I register bindingly for the Safe®-
Mentor Training Module 1-4, and that I accept the conditions of
registration.
Please remit the amount to:
Recipient : Klinikum der Universität München
Bank : Bayerische Landesbank München
Account no. : 200 40
Bank code : 700 500 00
Keyword : Finanzstelle: SAFE®: 3.6.13, No.: 7411953
(please indicate exactly as given!)
For remittance abroad:
Swift : BYLADEMM
IBAN-no. : DE 41 7005 0000 0000 0200 40
Registrations will be taken into account according to sequence of receipt of
the money. You will receive the confirmation of receipt of money and the
related registration by e-mail. In case you explicitly would like to receive a
written confirmation by post, please tick here: □
You will receive your RECEIPT after termination of the SAFE® Mentor
Training together with your certificate.
Due to the considerable administrative expense, we can only make out an
invoice on special request. If you need an invoice, please inquire by mail or
phone.
With my signature I register bindingly for the SAFE®- Mentors- Training and I
accept the following participation- and cancellation conditions:
The registration is binding. A handling fee of € 50,- will be charged in case of
cancellation. In case of cancellation on short notice (after the 05.05.13) or
non-attendance, the complete amount will be charged, without any claim for
refund. The number of participants is limited.
The training and the achievement of the goals of the training are greatly based
on mutual reliance. If this base of reliance is not given, then it will not be
possible to reach the goals of the program. In this case the organizer has the
right to exercise his property rights and to exclude the participant from the
program. In this case the whole amount of registration fee will be refunded.