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14 th Congress of the European Society for Sexual<br />
Medicine<br />
Milan, 1 st -4 th December 2011<br />
<strong>ESSM</strong> Winter School - Milan, 28th Nov-30th November 2011<br />
<strong>HOTEL</strong> <strong>RESERVATION</strong> <strong>FORM</strong> <strong>DI</strong><br />
Please fill in and return within 20 th of November 2011 to AIM GROUP International - AIM Dmc - Milan<br />
Office Via Ripamonti, 129 - 20141 Milan – Italy - Tel. +39 02 566011 – Fax+ 39 02 56609043 e-mail:<br />
essm2011.hotel@aimgroup.eu<br />
PARTICIPANT (Please use CAPITAL letters)<br />
Family Name _____________________________________________________________________________________________________<br />
First name_______________________________________________________________________________________________________<br />
Address_________________________________________________________________________________________________________<br />
Postal Code___________ City _______________________________________________________________________________________<br />
Country ____________________________________________________________________________________________________________<br />
Tel._________________________________________________________________________________________________________________<br />
Fax_________________________________________________________________________________________________________________<br />
Tax identification/VAT numbe_________________________________________________________________________________<br />
E-mail___________________________________________________________________________________________________________<br />
I request to book:<br />
IBIS <strong>HOTEL</strong> MILANO CENTRO ***<br />
Via Finocchiaro Aprile, 2 – 20141 Milano<br />
single room (85,00 €) double room double use (93.50 €) twin room (93.50 €)<br />
Arrival date ___________ Departure date ___________ Total n. of nights ______<br />
Accompanying person’s name _____________________________________________________________<br />
Please note that rooms have been pre-booked from 27 th November to 4 th December 2011<br />
Rates are per room and per night, breakfast and all taxes included<br />
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14 th Congress of the European Society for Sexual<br />
Medicine<br />
Milan, 1 st -4 th December 2011<br />
<strong>ESSM</strong> Winter School - Milan, 28th Nov-30th November 2011<br />
I authorize to use the following credit card to guarantee my reservation:<br />
Visa Mastercard/Eurocard American Express<br />
Card no.: _____________________________________________________Security code/cvv2 *___________________________<br />
Expiry Date:________________________ Cardholder’s Name______________________________________________________<br />
Signature________________________________________________________________________________________________________<br />
*Security code/cvv2: last three figures appearing on the back of the card, in the signature space<br />
The credit card will be kept as a guarantee for the hotel reservation in case of penalty. No<br />
further cost will be charged on it.<br />
I agree that in case of cancellation AIM Group International – AIM DMC may charge the following<br />
amounts:<br />
CANCELLATION POLICY<br />
Any change or cancellation of the hotel reservation must be sent in written to AIM GROUP<br />
International - AIM Dmc .<br />
AIM GROUP International - AIM Dmc reserves the right to charge on the given credit card the following<br />
cancellation fees:<br />
- For cancellations notified up to 12.00 noon of 72 hours prior to the check-in date, no fee will<br />
apply and the deposit will be refunded.<br />
- In case of late cancellation or no shows, one-night stay will be charged.<br />
The payment of the total number of nights booked will be requested by the hotel upon check-out. The<br />
hotel will issue an invoice directly upon payment.<br />
Date _____________________Signature ___________________________________________________________________________<br />
PURSUANT IN<strong>FORM</strong>ATION ON LAW 196/2003<br />
AIM Group - AIM Dmc Srl, as data controller and/or processor, informs you that any personal data you provide, or any data received by third<br />
parties, will be used in connection to your participation to the Congress and/or to provide you with information regarding any other<br />
compatible activities organized by AIM Group or by its associates. Data treatment shall mean any operation, or set of operations, carried out<br />
with or without the help of electronic or automated means, and must guarantee the confidentiality and security of your personal data. AIM<br />
Group - AIM Dmc Srl, as data controller and/or processor may avail itself or its associates to carry out any of the following procedures: press<br />
releases, communications to clients, data processing and computer-based consultation. The data can be communicated to scientific<br />
associations, relative public or private agencies related to CME, financial and banking intermediaries, as well as companies participating in<br />
the Congress with promotional functions compatible with the purposes for which the data has been collected. The provision of your personal<br />
data is voluntary, but refusal will prevent your participation to the Congress. Under section 7 of the Legislative Decree no. 196 of 30 June<br />
2003 you have the right to object to the processing of your personal data for the purposes relevant to the collection, for purposes of sending<br />
advertising materials or direct selling or else for the performance of market or commercial communication surveys. Any requests can be<br />
addressed to: AIM Group - AIM Dmc Srl , Via Ripamonti 129, 20141 Milan, Italy.<br />
I authorize the treatment and communication of my personal data as described above.<br />
Date _____________________Signature ________________________________________________________________________<br />
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