Registration

Please transfer the amount, with mention of your name, until November 1, 2016 to the following account:

Account : 30-106-9
WNZ-009
Berner Kantonal Bank AG, 3001, Bern
IBAN: CH28 0079 0020 0800 0426 7
Inselspital-Stiftung, Stiftungen und Fonds, 3010 Bern

FIRST NAME : *
FAMILY NAME : *
TITLE : *
INSTITUTION : *
STREET & N° : *
POSTCODE : *
TOWN : *
COUNTRY : *
TEL : *
FAX :
E-MAIL : *
REGISTRATION FEE (Price includes coffee breaks, lunch and congress material) *	PHYSICIAN : CHF 100 NON PHYSICIANS : CHF 50