FINAL PROGRAM - EuroMediCom

ONLINE SECURED REGISTRATION ON: WWW.AMWC-CONGRESS.COM
Once your credit card debited we will destroy your payment details - Please do not send your registration scanned by email but only by fax.
Family ____________________________________________________________________________________________________________________________
Name
Use capital letters when completing this form
First ____________________________________________________________________________________________________________________________
Name
Medical Specialty (obligatory field)
____________________________________________________________________________________________________________________________
Clinic / Company
____________________________________________________________________________________________________________________________
Address ____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
Zip code City Country
____________________________________________________________________________________________________________________________
Phone ______________________________________________________
Fax
REGISTRATION FORM
Registration fees include: access to chosen sessions, workshops and commercial exhibit, coffee breaks, certificate
of attendance, congress bag and conference documents.
PASS 1 : AMWC - 3 DAYS (April 4 th - April 5 th - April 6 th )
Limited Seats!
2-YEAR FREE WOSIAM (World Society of Interdisciplinary Anti-Aging Medicine) & World MediSpa Association MEMBERSHIP offered with this registration (for MDs only): Advantages as member will start
after this registration. If you do NOT wish to become a WOSIAM Delegate, please tick here www.wosiam.org
PAYMENT
Bank check in Euros enclosed, payable to AMWC
TOTAL TO BE PAID: ...................................................€
Bank transfer in Euros to AMWC - ADD 15 € for bank charges
!!! VERY IMPORTANT: For administrative treatment purpose, BANK TRANSFER MUST BE MADE AT LEAST 10 DAYS PRIOR TO THE CONGRESS. Passed this date, the registrant may have
to pay on site his registration and will be eventually refunded after the congress. Administrative process may take up to 30 days to identify the transfer and proceed to the refund,
after the event. OBLIGATORY: Do mention the registrant’s name + AMWC 2013 reference on all the bank documents.
Paying bank: MON SDC MONACO
Address: Place des Moulins - 98000 Monaco
Account holder: AMWC Monaco
Bank code: 30002
Branch code: 03214
Account number: 0000060591D
Credit Card: Visa Eurocard / Mastercard American Express Diners
Credit card number: ___________ ___________ ___________ ___________
Cardholder’s name: __________________________________________________
Expiry date: ______ / ______ 3-digit code (obligatory): _____________
4-digit code (AMEX)
Cancellation policy: €
Cancellation will be processed after written demand and one month after the Congress
Mandatory ___________________________________________________________________
E-mail:
Your confirmation & invoice will be sent by e-mail - Please write as CLEARLY as possible
Includes: All AMWC sessions (aesthetic dermatology, anti-aging medicine, FAT and cosmetic gynecology symposium, workshops & visit of the exhibition – coffee breaks included)
Key digits: 75
IBAN: MC03 3000 2032 1400 0006 0591 D75
BIC - SWIFT: CRLYMCM1
Signature:
Before
01/03/2013
After
01/03/2013
& on-site
- DELEGATE RATE
PASS 2 : PRE-CONGRESS AME - AESTHETIC MASTER CLASS FOR EXPERTS - 1 DAY (Wednesday April 3 rd )
Includes: Pre-congress Aesthetic Master Class for Experts (AME) – coffee breaks and lunch (April 3 rd ) included
Workshop for advanced experts where the participants will simultaneously see LIVE localized injections made on a patient and the actual placement of a corresponding colored solution
under the dissected cadaver skin. Limited seats!
- DELEGATE RATE
PASS 3 : AMWC FULL PASS - 4 DAYS (April 3 rd - April 4 th - April 5 th - April 6 th )
Includes: All AMWC sessions (aesthetic dermatology, anti-aging medicine, FAT and cosmetic gynecology symposium, workshops & visit of the exhibition – coffee breaks, and 3 rd April lunch included)
+ Pre-congress Aesthetic Master Class for Experts (Wednesday April 3 rd )
- DELEGATE RATE
PASS 4 : AMWC EXHIBIT & WORKSHOPS ONLY - 3 DAYS (April 4 th - April 5 th - April 6 th )
- VISITOR PASS
PASS 5: AMWC VIP PLATINUM PASS - 4 DAYS (April 3 rd - April 4 th - April 5 th - April 6 th )
Includes: All AMWC sessions (aesthetic dermatology, anti-aging medicine, FAT and cosmetic gynecology symposium, workshops & visit of the exhibition – coffee breaks included).
+ Pre-congress Aesthetic Master Class for Experts (Wednesday April 3 rd )
+ VIP Services:
- VIP «Fast Track» counter (registration, badge & congress material delivery)
- Private Lounge access for 2 persons (permanent refreshment service in a sea-view room)
- DELEGATE RATE
AMWC - ANTI-AGING MEDICINE WORLD CONGRESS 2013
REGISTRATION FORM - TO BE SENT BY FAX TO +33 (0)1 56 837 805 (from America dial 011 33 1 56 837 805)
- GALA DINNER «FOREVER YOUNG» / Saturday April 6 th at the Sporting-club of Monaco
Please fill one form per registrant and send it (or copy) to: 2, rue de Lisbonne - 75008 Paris - France
Tel: + 33 (0)1 56 83 78 00 - Fax: +33 (0)1 56 837 805 - E-mail: amwc@euromedicom.com . registration@euromedicom.com
ON-LINE REGISTRATION: WWW.EUROMEDICOM.COM (Secured Payment)
Once your credit card debited we will destroy your payment details - Please do not send your registration scanned by email but only by fax.