Registration Form

The registration at Mediterretina 2015 is under fee. 22% VAT is included. The price are for one person

Partecipant Fee by 5th January 2015 € 280,00

Partecipant Fee by 5th February 2015 € 320,00

Partecipant Fee after 5th February 2015 € 390,00

Accompanying person by 5th February € 80,00

Accompanying person after 5th February € 110,00

Young OPHTHALMOLOGISTS (< 36 years old )

Partecipant fee by 5th February 2015 € 160,00

Partecipant fee after 5th February 2015 € 220,00

Transfert by bus from Venice to Cortina € 35,00

Transfert by bus from Cortina to Venice € 35,00

ACCOMODATION

VENICE

Check in 4th March check out 5th March at Hotel Monaco & Grand Canal

Single room € 188,00

Double room € 198,00

Welcome dinner at a tipical restaurant on 4th March € 80,00

CORTINA

Check in 5th March check out 8th March at Hotel Miramonti Majestic

Hotel Accommodation for 4 days 3 night - Prices include accommodation HB (drink excluded) + 1 lunch + 2 dinners

Double room (for person) € 345,00

Farewel Dinner 7th March € 80,00

Cancellation penalties: 30% from 90 to 30 days before arrival,50% from 29 to 15 days before arrival, 75% from 14 to 7 days before arrival, 100% beyond these limits.

Registration fee covers the following: partecipation Scientific Session, Congressual kit, Attendance Certificate, Gadget. For those not skiing and for accompanying person we will arrange a mini bus for a tour of the beautiful settings of Cortina.

For registration you must fill in every field of the form

The registration accepted will be confirmed by Organazing Secretary

For payment you can pay with bank transfet

It is possible to pay by credit card or by bank transfer to Events srl.

COMPANY NAME :EVENTS SRL

BANK NAME : VENETO BANCA
IBAN IT88S0503521300446570030418

SWIFT/BIC VEBHIT2M

REFERENCE: NAME OF PARTECIPANT(S) - Registration fee MEDITERRETINA 2015

Please send a copy of the bank transfer to the fax number +39 0719252094

See more details at www.mediterretina.com website

Personal data

First name
Last name
Birth place
Date of birth
Month
Year
Address
Zip code
City
Country
Phone
Cellular phone
E-mail
If you double up the Hotel room with a colleague write his name
If you bring some companions write the names,

ORGANIZATION

Istitution/University
Address
Zip code
City
Country

PRIVACY

Pursuant to the Italian Privacy Law 196/03, please be informed that your personal data will be processed confidentially by Events srl. Autorizzazione al trattamento dei dati personali in base all'informativa ai sensi del D.Lgs 196/2003. I dati saranno utilizzati ai fini delle operazioni di segreteria e potranno essere trasmessi a fornitori intervenuti nell'evento in oggetto. Il conferimento di tali dati è obbligatorio per l'iscrizione all'evento. Titolare dei dati è Events srl. La spunta nella sottostante casella "Acconsento" costituisce la presa d'atto della presente informativa e consente il trattamento dei dati personali come sopra citato. Con la presente si autorizza inoltre l'eventuale pubblicazione di fotografie effettuate durante l'evento

I agree to these terms
- I agree

Invoice data

These section must be complete only if subject invoice data are differents from the personal data

Customer name of invoice
Month
VAT
Fiscal code only for italian
Invoice address
Zip code
City
Country

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