BRICKLESS CENTRE 8-9 September, 2015 Registration for meeting of the Danish Consortium for NMD and Brickless Centre The annual meeting of the Danish Consortium for NMD and Brickless Centre will be held at Musholm – Ferie Sport Konference – for further information, please visit www.musholm.dk Note that there is an early fee before 15 June and a late fee after 15 June. Upon receipt of your registration form, you will receive an invoice by email. Please fill in and print out form and send or email to: RehabiliteringsCenter for Muskelsvind Kongsvang Allé 23 DK - 8000 Aarhus C, Danmark Contact person: Annette Mahoney, Tel.: +45 8948 2222, e-mail: [email protected] Before 15 June Danish Consortium for NMD (7 September - 10.00 - 17.00) ⃝ DKK After 15 June 600 ⃝ DKK 800 ⃝ DKK ⃝ DKK 650 800 Note: If you sign up for Brickless 8-9 September including accommodation, participation in the Consortium meeting on 7 September is free of charge. I would also like to participate in the reception for Birgit Steffensen ⃝ Accommodation and breakfast 7-8 September In shared double room In single room ⃝ DKK ⃝ DKK Brickless Centre (8 September, 09.00 - 9 September, 12.00) In shared double room In single room ⃝ DKK 2,000 ⃝ DKK 2,200 ⃝ DKK 2,300 ⃝ DKK 2,200 Brickless Centre (8-9 September without accommodation) ⃝ DKK ⃝ DKK 1,700 550 700 1,500 Brickless Centre (8 September without accommodation and dinner) ⃝ DKK 600 Total ⃝ DKK 800 DKK____________________ page 1 of 2 BRICKLESS CENTRE 8-9 September, 2015 Workshop session 8 September: ⃝ 1: Medical management ⃝ 2: Social management, education and job ⃝ 3: Physical assessment and rehabilitation I would like to present a project on 9 September. Project title: ________________________________________________________________________________________ ________________________________________________________________________________________ Name Profession Place of work Email Invoice address Organization/Company_________________________________________________________ Address______________________________________________________________________ City and zip code______________________________________________________________ Country______________________________________________________________________ Email________________________________________________________________________ EAN number (Only in Denmark) page 2 of 2
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