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

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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
EGA CONFERENCE 10 th / 11 th November 2003__________________________________________Please fax completed form to the Sheraton Roma by September 22 nd , 2003After that date all reservations are subject to hotel availabilityAttn. ReservationFAX: (06 5940689 or 06 5940555)or byE-mail: res497sheratonroma@sheraton.comorCalling your local toll freeMentioning conference block name : EGA091103________________________________________________________________________________please type all information!Last name________________First name___________________Arrival Date_______________Nationality________________Birthplace________________Phone nr_________________Estimated Arrival Time________(hotel check-in time:15.00 hrs)Departure Date_______________Passport nr__________________Birth date____________________Fax nr_______________________Estimated Departure Time________(hotel check-out time:10.00hrs)Special Rates for Classic double room for single use Euro 220,00 per night Classic double room Euro 268,00 per night Club double room for single use Euro 242,00 per night Club double room Euro 296,00 per night Executive double room for single use Euro 286,00 per night Executive double room Euro 360,00 per nightAbove rates include taxes and buffet breakfast.To confirm your reservation booking must be guaranteed by credit card or deposit of first night. Mastercard / Eurocard Diners Club Visa/Carte Bleu Amex OthersNumber ____________________________ Holder's name __________________________Exp. Date ___________________________ Signature ____________________________Hotel Reservation Policy:• Reservations must be made through The Sheraton Roma. A block of rooms has been reserved for 160delegates. First cut off date September 22 nd , 2003. After that date all reservations are subject to hotelavailability• Group rates will apply up to three (3) days before and after the group dates based on availability of rooms• Cancellation Policy: Reservations may be cancelled up to 72 hours prior to arrival date. All other cancellationsand no-shows are subject to a one night room and taxFor further personal correspondence please use following numbersSwitchboard Tel. +39 06 5453.1 Fax +39 06 5940689/5940555
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