| Prof. Dr. Jörn Scheer
Dept of Medical Psychology Friedrichstr. 36 D-35392 Giessen Germany Fax: ++49-641-99-45689 |
Name:
Address:
Phone / Fax / email: |
| Registration fee for the conference (including meals, coffee etc. during the conference, without Gala Banquet) | DM 500 | . | |
| Registration fee for the conference (including meals, coffee etc. during the conference, without Gala Banquet) (Full-time students, unemployed) | DM 400 | . | |
| Registration fee for the conference (including meals, coffee etc. during the conference, without Gala Banquet) (One night) | DM 100 | ||
| Accommodation (A) (5 nights)
Double room to share with: (1 night, single) |
Single
Double (1 night) |
DM 475
DM 250 DM 95 |
. |
| Accommodation (B) (5 nights)
Double room to share with: |
Single
Double |
DM 475
DM 250 |
. |
| Accommodation (C) (5 nights)
Double room to share with: |
Single
Double |
DM 600
DM 300 |
. |
| Please indicate order of preference of accommodation (A, B, C) due to availability: | |||
| I SHALL ARRANGE FOR ACCOMMODATION MYSELF | |||
| Gala Banquet Boat Cruise | DM 80 | . | |
| Trip to Potsdam and Sanssouci | DM 60 | . | |
| AFTER MARCH 1st, 1999, ADD LATE REGISTRATION FEE! | DM 30 | . | |
| Total amount due | . |
| Special nutrition requirements (e. g. vegetarian): |
Modes of Payment
| Master Card / Visa | Nr.:
|
Exp. Date | Signature: |
| Transfer amount to: | Prof. Dr. Scheer | Bank f. Gemeinwirtschaft Giessen | No. 200 18812 01,
BLZ 513 101 11 |
| Send "Eurocheque" (in DM) to: | Prof. Dr. Scheer | Address as above |