I NATIONAL
21-24 October 2014
Akka Antedon Hotel / Kemer, Antalya
VETERINARY MEDICINES
MICROBIOLOGY CONGRESS
REGISTRATION FORM
with International Attendance
PARTICIPANT
Name
Surname
Institution
 Female
Title
Contact Address
Postal Code
Phone 0 (
REGISTRATION FEE
Gender  Male
City
)
Email
Mobile 0 (
)
Fax 0 (
)
Registration Fee
Registration
Instructor (Mbr of the Associaton)
 210 TL
Instructor
 250 TL
Other (Mbr of the Associaton)
 180 TL
Other
 210 TL
Total
TL
CANCELLATION
PAYMENT OPTION
Bank Transfer
Account Holder
VETERİNER HEKİMLERİ MİKROBİYOLOJİ DERNEĞİ
Bank
TÜRKİYE İȘ BANKASI
Branch
DIȘ KAPI ȘUBESİ
TL IBAN
TR85 0006 4000 0014 2060 8265 76
Date : .......................................
I transfered _______ TL, at __/__/2014.
Signature : .......................................
(The payment transfer document is enclosed)
Cancellation for the registration until 21 August 2014 will be refunded.
Cancellations after this date won’t refund. All refundswill be processed
after the end of the congress.
Cancel Type
Cancellation Date
Early Cancel
21.08.2014 and before
End of the congress
Refund Details
Late Cancel
22.08.2014 and after
No refund
I hereby agree to be bound by the rules and regulations of the congress by submitting this form.
Date : .......................................
Signature : .......................................
This form should be faxed or emailed to Congress Secretariat. This form is valid only for one participant.
Claros Tour, Alico Turizm Ltd. Sti. 1469 Sokak No:18 (35220) Alsancak / İZMİR Phone +90 232 421 00 11 • Fax: +90 232 463 23 84
www.vetmik2014.org | E-posta: [email protected]

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