Please return until 20/03/2017:
MCI Deutschland GmbH
MCI | Germany – Berlin
Markgrafenstr. 56
D-10117 Berlin
Issued on: 07/02/2017
T: +49 30 20459090
F: +49 30 2045950
[email protected]
REGISTRATION FORM
Berlin BRAIN & BRAIN PET 2017
28th International Symposium on Cerebral Blood Flow, Metabolism and Function
13th International Conference on Quantification of Brain Function with PET
April 1st – 4th 2017, Henry-Ford-Bau, Garystraße 35, 14195 Berlin
Please note that the organiser would prefer online registration at: http://www.brain2017.net/
PLEASE USE BLOCK CAPITALS
PLEASE USE ONE FORM PER PARTICIPANT
A. Participant information
Mr.
 Ms./Mrs.
Professor
Dr.
_________
                          
Family Name
First Name
Private address or Clinic/Business address
                          
Institute/ University
                          
Department/Clinic
                          
Street
No.
Country
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Zip Code
City
To receive your confirmation on time, please double-check your data before returning this form:
                          
Country+Area Code No.
Phone No. (during work hours)
Fax No.
                          
E-Mail Address
B. Registration fees
Category
Early
until January 26th 2017
Regular
until February 23rd 2017
Late
after February 23rd 2017
ISCBFM Members* Country List A
 € 575
 € 675
 € 730
ISCBFM Members* Country List B
 € 400
 € 490
 € 580
Non-Members Country List A
 € 680
 € 780
 € 830
Non-Members Country List B
 € 500
 € 590
 € 680
ISCBFM Students Members* & **
 € 240
 € 290
 € 390
ISCBFM Students Non-Members
 € 290
 € 340
 € 450
BrainPET Sessions only***
 € 350
 € 400
 € 530
CARNet Meeting & Conference Attendee
 € 650
 € 750
 € 830
CARNet Meeting & Conference Student**
 € 365
 € 415
 € 550
All fees are indicated including German VAT.
Please note that it is not possible to register in category B AND C. If you wish to attend the BRAIN 2017 Conference and the
CARNet meeting, please select "CARNet meeting & Conference Attendee/Student".
Registration fees include: Participation in all scientific sessions, conference publications including collection of all abstracts,
access to the exhibition area, invitation to the welcome reception, congress bag, and refreshments.
Country Lists A & B: Developing countries are defined according to the World Bank Country Classification of Low income and
Lower-middle-income economies; see appendix on page 5/6 for more information on the Country Classification data according
to the World Bank website.
*
**
***
In order to apply for this category, please ensure your ISCBFM membership is approved and fees are paid for 2017 before you start the
registration process. Registration will not be confirmed otherwise.
I certify to be entitled to the reduced registration fee. Appropriate proof of student status is attached to this registration form.
Participation in BrainPET Sessions ONLY (on Sunday, 2nd April & Monday, 3rd April 2017).
C. Day ticket April 1st 2017
Category
Early
until January 26th 2017
Regular
until February 23rd 2017
Late
after February 23rd 2017
CARNet Meeting Attendee
 € 150
 € 150
 € 200
CARNet Meeting Student**
 € 75
 € 75
 € 100
**
I certify to be entitled to the reduced registration fee. Appropriate proof of student status is attached to this registration form.
D. Course day
Category
Early
until January 26th 2017
Regular
until February 23rd 2017
Late
after February 23rd 2017
Educational Courses*
Brain/ BrainPET
 € 75
 € 75
 € 100
*
Educational Courses take place only on Saturday, 1st April 2017. Registration for the courses is only available to participants registered for
the Conference. Payment should be made in addition to the registration fees.
E. Evening events
Category
Date
Location
Price/
number of tickets
Welcome Reception
April 1st 2017, 5:30 pm
Henry Ford Building Berlin
yes
no
Early Career
Networking Evening
April 2nd 2017, 8:30 pm
Ballhaus Berlin
 € 15/ _____ ticket(s)
ISCBFM Banquet
April 3rd 2017, 8:00 pm
Wasserwerk Berlin
SOLD OUT
F. Hotel accommodation
Hotel
1st Choice
2nd Choice
Single room
Double
room
Distance
4* Ramada Plaza Berlin City Centre


 € 149
 € 159
8,1 km
4* Ellington Hotel


 € 218
 € 248
2,7 km
3* Ku’Damm 101 Design Hotel Berlin


 € 123
 € 148
6,4 km
Rates per room and night including breakfast and German VAT. All nights will be charged upon booking confirmation. Your
extras are to be paid directly at the hotel upon check-out. For further information on the hotel location and on the hotel facilities
please visit: http://www.brain2017.net/
For students: Berlin offers a lot of low cost hostels, hotels or private rooms. Please check and book online on berlin.de/;
hostelbookers.com; airbnb.de, in order to find accommodation that suits your pocket.
Your arrival date:
Your departure date:
Special requests (depending on availability)
 Non-smoking
 Smoking
 Wheelchair accessible
room
 Arrival after 6 p.m.
G. Sharing accommodation
Join the closed facebook group on http://www.brain2017.net/ if you are looking for a shared accommodation.
Alternatively tick below if you wish to share a room or just find accommodation with other congress participants. We will forward
your contact details to the admin of the closed Brain2017-facebook group.
 Yes
I am looking for someone to share accommodation with me.
 Yes
Yes, I agree that my contact details will be added to a mailing list which will be provided to the admin of the
closed Brain2017-facebook group.
Please note that you are solely responsible to contact and organize your shared room via Brain2017-facebook group.
H. METHODS OF PAYMENT
Only for German bank accounts:
 Zahlung per Abbuchungsauftrag (Nur bei Zahlung mittels deutschen Bankkarten möglich)
Hiermit bitte ich Sie widerruflich, die von MCI Deutschland GmbH für mich bei Ihnen eingehenden Lastschriften zu Lasten meines
Girokontos einzulösen. Wenn mein Konto die erforderliche Deckung nicht aufweist, besteht keine Verpflichtung, die Lastschrift einzulösen.
Für den Fall der Nichteinlösung durch mangelnde Kontodeckung verpflichte ich mich, MCI Deutschland GmbH die dadurch entstandenen
Kosten zu erstatten.
IBAN: DE/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/
BIC: __/__/__/__/__/__/__/__/__/__/
 Payment by credit card (Only for participants from abroad)
With my signature I authorize MCI Deutschland GmbH to charge my credit card upon confirmation with the GRAND TOTAL shown above as
well as with all extra fees resulting out of other hotel categories and/or rebookings.
 American Express
 Visa
 Eurocard/Mastercard
Card Number: __/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__/
Card Holder: ______________________________________________________
Expiry Date: __/__/ / __/__/
CVV2/CVC2 (required): __/__/__/__/
[Visa/Eurocard: last 3 digits by the signature on the back of the card, Amex: the 4-digit number
printed above the card number on the front]
Telephone or email registrations cannot be accepted. Duplicates of cheques, purchase orders and/or bank transfers are also
not accepted.
Please note: registration and services booked can only be confirmed upon receipt of full payment.
 I hereby allow my details to be passed on to sponsors and exhibitors at 28th International Symposium on Cerebral
Blood Flow, Metabolism and Function/ 13th International Conference on Quantification of Brain Function with PET
I accept, (on behalf of and including all above mentioned persons) the general terms and conditions and the data protection
provisions. I agree that my/our personal data may be used within the scope of this meeting. I agree, where necessary, that this
data may be transferred to 3rd parties (e.g. hotels, travel agencies, airlines etc.) that are involved in the organisational process. I
agree that our contact details may be used to promote any events organized by MCI Deutschland GmbH. (This includes email
newsletters, or mail distribution etc.) The collection, processing and use of this data is carried out in compliance with the
German data protection laws (BDSG), and under the supervision of our data-protection representative.
I understand that I may deny the promotional use of my/our personal details by crossing out this paragraph or by contacting
MCI Deutschland GmbH directly: Tel. (+49 (0)30 20 45 90 – standard tarif), Post (MCI Deutschland GmbH, Markgrafenstraße
56, Berlin, D-10117), Email, ([email protected])
I/We agree to electronic credit card cashing and accept the stated terms and conditions.
Date: ____________________________________________ Signature: ___________________________________________

General Conditions:
Registration / Confirmation / Cancellation
26th
Deadline for Early bird registration is January
2017.
Deadline for pre-registration is March 20th 2017.
Registration and services booked can only be confirmed
upon receipt of full payment or valid credit card details.
In case of cancellation of participation until January 26th
2017 registration fees will be refunded. A handling fee of
EUR 40 respectively EUR 20 for course cancellation per
person will apply. The registration is nonrefundable after
that date. Name changes incur a handling fee of EUR 10
per registration. In case of no-show or early departure no
refund of registration fees will be made. The organizers will
only accept request for refunds if they are in writing.
Should you have any special requests for the processing of
your invoice, kindly let us know when submitting your
registration form. The re-issuing of an invoice incurs a
EUR 10 handling fee.
Prices of sub-contractors are based on the current tariffs
and VAT rate. All prices and details, beyond our control,
are subject to change.
Hotel Accommodation
The selected hotels have limited capacities. It is
recommended to make your hotel booking as early as
possible. If the desired hotel/ category is already fully
booked, MCI Deutschland GmbH reserves the right to
arrange accommodation in another hotel/ category.
All changes and cancellations are to be made in writing
and addressed solely to MCI Deutschland GmbH.
In case of partial or full cancellation of the hotel reservation
until January 26th 2017 a handling fee of EUR 20 per
person will be charged.
Thereafter and until February 23rd 2017, if one hotel night
is cancelled, this hotel night will be charged. In case of
partial or total cancellation of two or more hotel nights, 50%
of the booked hotel nights will be charged. In case of
cancellation or no-show without prior notice after February
23rd 2017 all hotel nights reserved will be charged. In case
of no-shows the right to the booked hotel room expires the
following day at 9 am local time.
For name changes and changes regarding the arrival and
departure dates (no partial cancellation) a processing fee
of EUR 20 per booking will be charged.
The hotel is reliable for damages if the reserved room is not
made available.
To secure adequate overnight capacities, hotel rooms for
the meeting had to be contracted long time in advance.
Hotels may publish online or last-minute promotion rates
for a limited number of rooms which may vary from the
prices contracted for the meeting.
Social Program/Evening Events
Each program/event requires a minimum number of
participants. If the minimum number is not reached until 14
days prior to the meeting, the program/event in question
will be cancelled and a full refund will be given. Should an
individual cancel their own participation, no refund will be
issued. Participants take part in all programs/events at their
own risk.
Legal Conditions
If a third party takes over the contract from a guest, both
parties are liable for payment of the invoices as well as for
the rebooking fees. MCI Deutschland GmbH’s liability for
damages – not including personal injuries– is limited to
three times to the total invoice amount, provided that the
damage is not caused deliberately or in a negligent
manner.
The organizer of this event is MCI Deutschland GmbH. The
scientific program is under the responsibility of the scientific
committee.
These general terms and conditions and all subsequent
information are to be considered as the legal basis for all
reservations.
Verbal agreements are not binding, unless confirmed in
writing. All vouchers/documents will only be distributed
upon receipt of full payment. Please pay any balance on
time, as indicated on your invoice. There will be no refund
or replacement for lost or unused vouchers/ documents. If
the badge is lost or forgotten, a replacement badge will be
issued at a charge of EUR 10. Should the badge be mislaid
a second time, the individual would need to re-register
onsite at the published rates.
The participant acknowledges that he/she has no right to
lodge damage claims against the organizer should the
meeting or parts hereof be hindered or prevented by
unexpected political or economic events or generally by
force majeure, or should the last-minute cancellation of
speakers or other reasons necessitate programme
changes.
Act of God / Force Majeure
It is mutually agreed that in the event of total or partial
cancellation of the congress due to fire, strike, natural
disaster (either threatened or actual), government
regulations or incidents not caused by the organizer, which
would prevent its scheduled opening or continuance, this
agreement may be partially postponed or terminated as a
whole. In this case, participants are not entitled to reclaim
refunds on no account.
Participants are obliged to have a civil liability insurance.
In the case of cancellation, a timely shift or changes in the
duration of the event, the registration remains its validity.
However, in this case a cancellation is possible with prior
written consent of the organizer. Where justified, 25% of
the invoice amount will be due as a general measure of
compensation for costs occurred, payable by the applicant
to the organizer.
The proof of the non-occurrence of a loss damage or lower
losses occurred, expressly remains within the responsibility
of the applicant.
By completing the registration form, the participant agrees
that his/her data may be used, processed and published
(e.g. within the list of participants) for organizational
purposes of this and other meetings. The collection,
processing and use of these data is carried out in
compliance with the protection of data privacy, and under
the supervision of our data-protection representative.
Exclusive Court of Jurisdiction is in Berlin, Germany, the
head quarter of MCI Deutschland GmbH.
The Creditor Identifier of MCI Deutschland GmbH is:
DE60ZZZ00001064434
Seminar Insurance
In addition, we offer the opportunity to take out a seminar
insurance. Sickness, accident or any other unexpected
circumstances – also within your family – can occur and
make your participation impossible. The seminar insurance
with our partner – the European Travel Insurance Company
– covers these financial risks in case of cancellation. For
more details and for booking the insurance online please
visit the congress
website: http://www.brain2017.net/
Appendix: Country list A
Including
High-income OECD members/ High-income economies
Andorra
Germany
Poland
Antigua and Barbuda
Greece
Portugal
Argentina
Greenland
Puerto Rico
Aruba
Guam
Qatar
Australia
Hong Kong SAR
Russian Federation
Austria
Hungary
San Marino
Bahamas, The
Iceland
Saudi Arabia
Bahrain
Ireland
Seychelles
Barbados
Isle of Man
Singapore
Belgium
Israel
Sint Maarten (Dutch part)
Bermuda
Italy
Slovak Republic
Brunei Darussalam
Japan
Slovenia
Canada
Korea, Rep.
Spain
Cayman Islands
Kuwait
St. Kitts and Nevis
Channel Islands
Latvia
St. Martin (French part)
Chile
Liechtenstein
Sweden
Croatia
Lithuania
Switzerland
Curaçao
Luxembourg
Taiwan, China
Cyprus
Macao SAR, China
Trinidad and Tobago
Czech Republic
Malta
Turks and Caicos Islands
Denmark
Monaco
United Arab Emirates
Equatorial Guinea
Netherlands
United Kingdom
Estonia
New Caledonia
United States
Faroe Islands
New Zealand
Uruguay
Finland
Northern Mariana islands
Venezuela, RB
France
Norway
Virgin Islands (U.S.)
French Polynesia
Oman
Upper middle income economies
Albania
Fiji
Namibia
Algeria
Gabon
Palau
American Samoa
Grenada
Panama
Angola
Iran, Islamic Rep.
Paraguay
Azerbaijan
Iraq
Peru
Belarus
Jamaica
Romania
Belize
Jordan
Serbia
Bosnia and Herzegovina
Kazakhstan
South Africa
Botswana
Lebanon
St. Lucia
Brazil
Libya
St. Vincent and the Grenadines
Bulgaria
Macedonia, FYR
Suriname
China
Malaysia
Thailand
Colombia
Maldives
Tonga
Costa Rica
Marshall Islands
Tunisia
Cuba
Mauritius
Turkey
Dominica
Mexico
Turkmenistan
Dominican Republic
Mongolia
Tuvalu
Ecuador
Montenegro
Source: http://data.worldbank.org/about/country-and-lending-groups, 5th May 2016
Appendix: Country list B
Lower middle income/ low income
Afghanistan
Guyana
Philippines
Armenia
Haiti
Rwanda
Bangladesh
Honduras
Samoa
Benin
India
São Tomé and Principe
Bhutan
Indonesia
Senegal
Bolivia
Kenya
Sierra Leone
Burkina Faso
Kiribati
Solomon Islands
Burundi
Korea, Dem. Rep.
Somalia
Cabo Verde
Kosovo
South Sudan
Cambodia
Kyrgyz Republic
Sri Lanka
Cameroon
Lao PDR
Sudan
Central African Republic
Lesotho
Swaziland
Chad
Liberia
Syrian Arab Republic
Comoros
Madagascar
Tajikistan
Congo, Dem. Rep.
Malawi
Tanzania
Congo, Rep.
Mali
Timor-Leste
Côte d'Ivoire
Mauritania
Togo
Djibouti
Micronesia, Fed. Sts.
Uganda
Egypt, Arab Rep.
Moldova
Ukraine
El Salvador
Morocco
Uzbekistan
Eritrea
Mozambique
Vanuatu
Ethiopia
Myanmar
Vietnam
Gambia, The
Nepal
West Bank and Gaza
Georgia
Nicaragua
Yemen, Rep.
Ghana
Niger
Zambia
Guatemala
Nigeria
Zimbabwe
Guinea
Pakistan
Guinea-Bissau
Papua New Guinea
Source: http://data.worldbank.org/about/country-and-lending-groups, 5th May 2016