Delegate Details

Country of residence

First and last name

Title

Specialisation

Telephone (with country and area code)

Fax

Mobile phone

E-mail address

Billing information

Full name of institution/organization

Tax Identification Number

Country

City/Town

Postal code

Address

Telephone

Fax

I would like to register for: first day: course fee is EURO 200 - payment before day of Course, EURO 250 – payment at the course; per person Registration fee includes: access to all lectures and live surgeries (during first day), course book, coffee breaks, certificate of attendance, conference bag and badge first day: special course fee for Medical Students and Physical Therapists and is EURO 100 - payment before day of Course, EURO 150 – payment at the course; per person Registration fee includes: access to all lectures and live surgeries (during first day), course book, coffee breaks, certificate of attendance, conference bag and badge second day: course fee is EURO 500 - payment before day of Course, EURO 550 – payment at the course; per person Registration fee includes: access to all lectures and practical sessions (during second day), course book, lunch and coffee breaks, certificate of attendance, conference bag and badge first + second day: course fee is EURO 700 - payment before day of Course, EURO 800 – payment at the course; per person Registration fee includes: access to all lectures and practical sessions (during second day), course book, lunch and coffee breaks, certificate of attendance, conference bag and badge

Participation conditions: Please submit the completed registration form by fax (+4822 355 85 18) or by online registration via our website, and make payment of course fee no later than on the day of Course. Number of participants are limited. Payment: Payment to the account of Centrum Edukacji Medycznej CEMED Sp. z o.o., ul. Pory 78, 02-757 Warszawa, Polska, number: BPKOPLPW PL 70 1020 1169 0000 8602 0107 6488, title transfer: "name:………………., 3-rd UPPER LIMB COMMITTEE COURSE" Registration confirmation: A confirmation letter will be sent by e-mail and by fax to the address and number given on the registration form, 14 days before the date of the course. If you have to receive a confirmation letter earlier, please contact organizer’s office at +48 22 355 85 03 or e-mail to m.domanska@cemed.pl

Cancellation policy and refunds: To cancel your conference registration, you must submit a written request. Telephone calls will not be honored. Please fax at + 48 (22) 355 85 18 or e-mail to cemed@cemed.pl. Cancellations will be confirmed by the organizers in writing. Cancellations received on or before October 25th, 2010, are entitled to a full refund. After October 25th, 2010, no refunds can be given. However, substitutions will be accepted anytime up to the course date at no extra cost. Any refunds will be issued after the conference. Registered participants who do not attend the conference and have not submitted a written cancellation or substitution request will be invoiced for the full amount outstanding. If for any reason beyond our control we are forced to cancel the meeting, the fee already paid will be reimbursed as soon as possible. Cancellation of reservation for travel, accommodation and the like will be the sole responsibility of the participant. We will be unable to reimburse any losses and cancellation fees. The data you provide will be held on a database in accordance with the law of Republic of Poland (ustawa z dnia 29 sierpnia 1997 r. o ochronie danych osobowych, t. jedn. Dz. U. z 2002 r. Nr 101, poz. 926). Occasionally your details may be passed to sponsors and or endorsers who have supported event at which you attend, and who wish to contact you for related purposes. If you do wish your information to be changed or deleted, please write to the Database Manager at Centrum Edukacji Medycznej CEMED Sp. z o.o., 02-757 Warszawa, ul. Pory 78, Poland.