Online Registration Form for Neuropathology 2002 Congress
Helsinki, Finland, 13-16 July 2002

 Instructions: Press [Tab] to proceed from one field to the next one or click with mouse to the next field.

 Participant information

 Please fill in your contact information below. 
Last (family) name
First (given) name
Organisation
Mailing address
Post code and city
Country
Telephone (international)
Telefax (international)
E-mail address
Special diet or other requests
 Congress fees Choose one of the options below.
Participants, paid by 15 April 2002 EUR 350
Participants, paid after 30 April 2002 EUR 450 
Students *, paid by 30 April 2002 EUR 250 
Students *, paid after 30 April 2002 EUR 350 

* Graduate Students and trainees of medical specialities should provide a certificate of student status.

Accompanying persons, paid by 30 April 2002 EUR 30 
Accompanying persons, paid after 30 April 2002 EUR 50 
 Accompanying person(s)

... will be travelling with me
Name(s) of accompanying person(s)
1  Subtotal - Congress Fee(s)

EUR

 Social programme

 Please indicate number of persons below.

 Opening Ceremony and Get-together Sat, 13 July Free

 Congress Dinner at Suomenlinna Sea Fortress  Sun, 14 July EUR 50

 Helsinki City Reception at City Hall Mon, 15 July Free

2

  Subtotal - Social Programme

EUR

 Tour programme

 Please indicate number of persons below.

 Helsinki City Sightseeing Sun, 14 July EUR 30  

 Cultural Tour to Hvitträsk and Gallen-Kallela Museum Mon, 15 July EUR 90  

 St.Petersburg Tour to Russia (sgl suppl. EUR 110) Wed-Fri, 17-19 July EUR 720 (+EUR 110)  

3

  Subtotal - Tour Programme

EUR

 Hotel accommodation

 Please specify your choices below.

Please book hotel for me.

I will make my own hotel arrangements.
First Hotel Choice
Second Hotel Choice
Room Type
Arrival Date
Departure Date
Special requests for hotel accommodation

4

  Hotel deposit per room EUR 120 per room

EUR

 TOTAL DUE IN EUR ( = Subtotals 1 + 2 + 3 + 4 )

EUR

 Method of payment Choose method of payment below.
Bank transfer payment.
Bank: Aktia Bank, Finland Acc.holder: Neuropathology 2002, c/o CONGREX
Acc. number: 405529-289226 SWIFT address: HELSFIHH
Credit card payment. My credit card information is listed below.
Credit card payment. I will send credit card details by telefax to +358-9-56075020.
Card number (eg. 4444 5555 6666 7777)
Expiry date of the credit card (MM/YYYY)
Last 3 digits on the signature panel of the card (See numbers on reverse side of the credit card)
Name of the credit card holder
Signature of the credit card holder Please send the signature of the card holder by telefax.

 Other requests

 Please indicate any other requests below.
 Print and submit Please print this form for your record before submitting it.
Click "Submit" to send the information given above to CONGREX.
Click "Reset" if you wish to clear the information without submitting it.