28-29 June 2013 - Dr. Falk Pharma GmbH

REGISTRATION
Please register via our website www.complications-in-endoscopy.com or complete this registration form and fax it to
+49 (0)89 / 89 06 77-77. The final registration date is 21 June 2013. Please register after this date on site.
PAYMENT
Please choose between bank transfer or credit card payment.
� bank transfer
Please pay the total amount to the following account:
Account holder: COCS GmbH
Bank name: HypoVereinsbank München
Bank code: 700 202 70
Account: 39613140
IBAN: DE30 7002 0270 0039 6131 40
BIC: HYVEDEMMXXX
Reference: CIE2013 & name of the participant
All bank charges must be covered by the participants
directly.
CANCELLATION
Congress Registration
Cancellation in written must be received not later than 14 June 2013. A service fee of 20.- € will be deducted from the refund
amount. Registration fees will not be refunded if cancellations are received at a later date.
HOTEL RESERVATION
We kindly ask you to settle all additional expenses during check out at the hotel.
� credit card (Visa or Master)
_________________________________________
Name of credit card holder
_________________________________________
Credit card number
_________________________________________
Exp. Date (Month/Year)
I hereby authorize COCS GmbH to charge the total amount
from the credit card.
Changes in reservation and cancellations must be reported in written to COCS GmbH (not to the hotel). If the guest cancels a
reservation prior to 26 April 2013 a cancellation fee of 20,- € per room reservation and per night will be charged; any bank charges
that may arise as a result of such a cancellation will be covered by the guest him-/herself. After that date, COCS GmbH and the
hotel certainly try to resell cancelled rooms, but if this is not possible the cancellation fee of the hotel (up to 100% of the room
rate) will be charged to you.
Please also be aware in the case of a later arrival or an earlier departure some hotels will charge you the total number of nights
booked, if the nights cannot be resold.
_____________________________________________________________________________________________________________________
Date, Signature
For further questions, please do not hesitate to contact:
COCS GmbH – Congress Organisation C. Schaefer – Rosenheimer Str. 145c – 81671 Munich, Germany
Tel: +49 (0)89 / 89 06 77-23 – Fax: +49 (0)89 / 89 06 77-77 – E-Mail: nina.toy@cocs.de