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REGISTRATION FORM

If you do not receive confirmation of your on-line registration by e-mail, we kindly ask you to confirm your registration by email or fax: cgrbesic@kbsm.hr or fax +3851-3768-293 (Hotel reservation should be made through Reservation form)

Fields marked with * are required.
* Family Name:   
* First Name:   
Hospital/Institution: 
Department: 
Adress: 
City and Code: 
Country: 
Tel: 
Fax: 
* e-mail:   

Primary Area of expertise. (please check where appropriate)
ENT
Allergist
Pulmonologist
Basic research
Pediatrician
Other

Registration fee.
  Early registration (before 15th September 2008) Late registration (later than 15th September 2008) On-site registration
EAACI member > 35 years 400 Eu 450 Eu 500 Eu
EAACI JMA member 300 Eu 350 Eu 400 Eu
Non-EAACI member 500 Eu 550 Eu 600 Eu

EAACI membership is offering a discount on registration. To get more one EAACI membership visit website www.eaaci.net. Please, note that EAACI membership for juniors (< 35 years) is free of charge.

Registration fee is to be paid only by the bank transfer to the account:

Croatian Society of ORL/Head and Neck surgery of Croatian Medical Association

ZAGREBACKA BANKA
Account no. 2360000-1101214818
SERIN subaccount 268-18-1
IBAN: HR7423600001101214818
SWIFT: ZABAHR2X



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