SOLTI Madrid 2011

MADRID | 18 - 19 NOVEMBER 2011

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Scientific secretariat

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Registration & Lodging Form

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Registration and Lodging Form

PERSONAL DATA

*Mandatory data

*Last Name:

*First Name:

Department:

Institute/Hospital:

*Address:

*Postal Code:

*City:

*Country:

*Telephone:

Fax:

*E-mail:

*Passport number:

REGISTRATION FEES

*Mandatory data

Registration Fees	Until October 21^st 2011	From October 22^nd to November 17^th	On Site

ESMO MEMBERS	300 €	350 €	400 €

NON ESMO MEMBERS	400 €	450 €	500 €

RESIDENTS / FELLOWS*	200 €	250 €	300 €

18% VAT included

a) Procedures

By fax:
Registration forms should be completed and sent by fax to the Secretariat. Information must be printed or typed, Your name should be written as you wish it to appear on your badge.
On-line:
Registration form should be completed and sent following the Indications. Please complete the above registration form on-line with all your data and keep a copy for your records.

* Applicants must submit a letter from their Department Head as proof of full time enrollment in a specialty-training program in the current academic year. Participants unable to provide the necessary proof will be subject to paying the ESMO Member or Non ESMO Member fee.

b) Registration fee includes
Registration fee includes addmittance to scientific sessions, official congress materials, certificate of attendance, coffee, luncheon on Friday, November 18^th and Congress Dinner.

c) Confirmation
Registrations will be confirmed by e-mail, upon receipt of the registration form and fee. An attendee is not registered until full payment is received. Please present the confirmation at the Conference Registration desk to collect the documents. If you do not receive the confirmation kindly contact the secretariat.

d) Cancellation
Notification of cancellation must be sent in writing to the Secretariat.
Cancellations received by October 30^th, 2011 will be reimbursed except 20% of handling fee.
After this date no refunds will be made.

e) Payment
Payments should be made in Euro. They can be made with credit card (Visa, Eurocard, Master Card) or by bank transfer. Please see registration form.

TOTAL REGISTRATION FEE: Rellenar el formulario anterior.

PAYMENT

*Mandatory data

By bank transfer

By card

Payments should be made in Euro to: SOLTI By bank transfer to: Bankinter Account no.: 0128 0892 51 0500531251 IBAN: ES10 0128 0892 51 0500531251 (Please enclose copy of payment with your registration form) Please send copy of payment to fax no. 00 34 91 571 92 06 or enclose a file (JPG, GIF or Word format) by clicking in "Payment receipt".
Payment receipt:

PLEASE, FILL IN FOR INVOICE PURPOSES (REGISTRATION)

Individual

Company

*Last Name:	*First Name:
*Passport number:	*Address for invoice:

MAILING LIST

Please remove my name from the mailing list.

(Directive 95/46 EC of the European Parliament and of the Council of 24th October, 1995, on the protection of individuals with regard to the processing of personal data and on the free movement of those data)

ACCOMMODATION

Yes No

HOTELS

Hotels	Single	Double

NH ABASCAL**** c/ José Abascal, 47 (15 min walking distance)	114 €	126 €

HIGH TECH EMBASSY **** c/ Serrano, 46 (11 min walking distance)	156 €	168 €

18% VAT included

Prices are per room and night. Breakfast, 18% VAT included.
Deadline for booking : September 30^th 2011. After that date, kindly contact the Secretariat for availability and prices.
Bookings are made from November 17^th to 19^th 2011. For other dates, kindly contact the secretariat.
Cancellation and reimbursement policy:

Cancellations or night reduction received prior to September 30^th, will be refunded less 30€ administration charge.
After that date, no cancellations or room reductions.
No-shows will not be refunded.
All cancellations should be sent in writing to the Secretariat.
All refunds will be dealt with after the conference.

HOTEL RESERVATION FORM

*Mandatory data

*Hotel:

Hotel 2^nd option:
Hotel 3^rd option:

*Single Rooms:

*Double Rooms:

*Date of arrival:

*Date of departure:

* All bookings should be accompanied by its corresponding payment to considered.

Please select on the form : hotel, room accommodation and dates of arrival and departure.

HOTEL PAYMENT

*Mandatory data

By bank transfer By card Same credit card as in the Registration Form

Payments should be made in Euro to:
BENEANDCO S.L.

By bank transfer to: Banesto
SWIFT: ESPC-ESMM
Account no.: 0030 - 8160 - 90 - 0000460271
Bank Address: C/ Francisco Silvela, 53. Nº 2 - 28028 Madrid.
(Please enclose copy of payment with your reservation form)

Please send copy of payment to fax no. 00 34 91 571 92 06 or enclose a file (JPG, GIF or Word format) by clicking in "Payment receipt".

IMPORTANT: If you wish to pay by bank transfer your registration and accommodation, you should make two different bank transfers, (please note there are two different bank accounts). You are entitled to send us the two copies of your payments, as registrations and accommodations are processed separately.

Copy of payment:

PLEASE, FILL IN FOR INVOICE PURPOSES (HOTEL)

Individual Company Take data from Registration invoice

*Last Name:	*First Name:
*Passport number:	*Address for invoice:

I have read and accept the legal disclaimer. Legal Disclaimer.

IMPORTANT: Once you press “SEND”, please wait a couple of minutes before pressing other keys, keeping the page open, until you receive the message: “Your data have been processed correctly”.

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