9th Annual EGA Conference - European Generic medicines ...

9 th EGA Annual Conference10 >11 November 2003Sheraton Roma Hotel I Via del Pattinaggio 100 I I-00144 Rome ItalyFor more info: www.egagenerics.com/events/events.htmMaking Medicines AffordableAPPLICATION TO REGISTER AT THE EGA CONFERENCE 2003TO BE SENT BACK BY FAX AT +32-2 736 74 38Title (Mr./Ms.): ............................. First Name: ................................................................................................................................................. Family Name: ...................................................................................................................................................Company: ............................................................................................................................................................................... Job title: .......................................................................................................................................................................................................................Company VAT No. and Country: ....................................................................................................................................................................................................................................................................................................................................................................Company Address: ..............................................................................................................................................................................................................................................................................................................................................................................................................Postal Code: ....................................................................................... City: ....................................................................................... Country: ...............................................................................................................................................................................................Tel N°: .................................................................................................................................................................................................................... Fax N°: .....................................................................................................................................................................................................E-mail: ..................................................................................................................................................................................................................... Website: .............................................................................................................................................................................................Please note all prices are inclusive of coffee breaks, lunches & conference dinner❑ My Company/Association is a Member of the EGA and will pay the Member Fee of euro 1,100.❑ My Company/Association is not a Member of the EGA and will pay the normal Non-Member Price of euro 1,600PLEASE NOTE THAT REGISTRATIONS ARE SUBJECT TO AVAILABILITY & WILL NOT BE EFFECTIVE UNTIL PAYMENT IS RECEIVED!Method of payment (please note that the bank charges are strictly your responsibility)❑ By Bank transfer to the account name: EGA Annual Conference, Account n° 210-0623976-27, Fortis Banque, 18 Place de Jamblinne deMeux, B-1030 Brussels, BIC/Swift code: Gebabebb, IBAN: BE48-2100-6239-7627, Bank tel: 32-2 734 3334.❑ By Cheque made out to European Generic medicines Association asbl (extra charge of euro 15), posted to: EGA P.O. Box 193, B-1040 Brussels.By ❑ Visa ❑ Eurocard/Master Card (American Express is not accepted) N°: ................................................................................................................................................................................................................................Cardholder’s: .............................................................................................................................................................................................Expire date: ..........................................................................................................................................................................................CVVorCVCNumber: .............................................................................................................................................................................................................................................................................................................................................................................................................Amount: .................................................................................................................................................................................................... Signature: ....................................................................................................................................................................................................CANCELLATION POLICY: cancellations must be made before the 1 October 2003. After this point we are NOT able to refund your fee. Should you be UNABLE toattend, a substitute delegate is welcome at no extra charge but until the 31 October 2003 only. Please note that registrations close officially on the 31 October2003 and they are also subject to availability .CONFERENCE ORGANISERS ARE NOT RESPONSIBLE FOR ACCOMMODATION BOOKINGFor hotel accommodation contact directly the Hotel Sheraton Roma - quoting EGA,IMPERATIVELY BEFORE the 22 of SEPTEMBER 2003 (after that the hotel cannot guarantee availability)Tel: +39-06 54537910, Fax: +39-06 5940555, E-mail: res497.sheraton.roma@sheraton.comHotel Shuttle available at the airport every hour, on the hourSignature: ........................................................................................................................... ............................... Date and Place: ......................................................................................................................................................................................................................If you need any information please contact:Cristina Romagnoli (cristina@egagenerics.com) Tel.: +32-2 533 9814 - Fax: +32-2 736 7438Making Medicines Affordable