1. No category

REGISTRATION FORM
Registration ID
(Office Use Only)
Please complete the form in capital letters and keep a copy for your records.
A separate registration form must be completed for each participant.
.......................................
Participant Information
Title :
Prof
Dr
Mr
Ms
First Name *:
Last Name *:
Institution *:
Department:
Address:
City *:
Province or State :
Postal or Zip Code:
Country *:
Telephone *:
(Including country code)
Fax:
(Including country code)
Mobile:
(Including country code)
E-mail * (Institutional):
@
E-mail * (Personal):
@
Accompanying Person Information
Title:
Mr
Ms
Title:
Mr
First Name *:
First Name *:
Last Name *:
Last Name *:
Dietary or other special requirements for:
(Please provide details)
Participant
Ms
Accompanying Person
Invoice Information
Institution Name:
Institution Address:
Tax Office:
Tax No:
Please fill in this form and send it to: DEKON CONGRESS & TOURISM
Gayrettepe Mah. Yıldız Posta Cad. Akın Sitesi 1. Blok No: 6 Kat: 1 D: 3 34349 Beşiktaş – Istanbul – TURKEY
Phone: +90 212 347 63 00 Fax: +90 212 347 63 63 E-mail: [email protected]
REGISTRATION FORM
Registration Information
Please select the appropriate registration category
Early Bird Registration
Type of Registration
Before or on March 24,
2015
USD 500
CWIG Registration / Member
Regular Registration
Between or on March 25
– April 28, 2015
USD 600
Late Registration
On or after April
29, 2015
USD 700
CWIG Registration / Non-Member
USD 600
USD 700
USD 800
ASCVTS Registration / Member
USD 500
USD 600
USD 700
ASCVTS Registration / Non-Member
USD 600
USD 700
USD 800
USD 250
USD 300
USD 350
USD 250
USD 300
USD 350
USD 250
USD 300
USD 350
USD 250
USD 300
USD 350
USD 250
USD 300
USD 350
Nurse & Perfusionist
1
1
Trainee
AATS-ASCVTS Post-Graduate Course
2
Adult on May 11, 2015
AATS-ASCVTS Post-Graduate Course
2
Congenital on May 11, 2015
AATS-ASCVTS Post-Graduate Course
2
Thoracic on May 11, 2015
USD 250
Accompanying Person
CWIG Gala Dinner on May 14, 2015
3
ASCVTS Gala Dinner on May 13, 2015
USD 125
USD 125
Registration Total:
Registration will be confirmed after receiving full payment. Those who do not receive a confirmation notice before the congress are
requested to contact the registration secretariat at [email protected] . Only participants who complete their registration
will be included in the program.
The date of payment is decisive for the registration fee. Even if the registration form is received before the early bird or regular
deadline, it will not be considered as early or regular registration if the payment has not been received before the deadlines.
th
Chest Wall International Group (CWIG) plans to take photographs and video material at the 16 CWIG Meeting in Hong Kong and
reproduce them in CWIG educational, news or promotional material, whether in print, electronic or other media, including the
th
CWIG website. By participating at the 16 CWIG Meeting in Hong Kong, you grant CWIG the right to use your name, photograph
and biography for such purposes. All postings become the property of CWIG. Postings may be displayed, distributed or used by
CWIG for any purpose.
I will attend the Live Surgery Demonstration on May 15, 2015 (Only those who are registered as CWIG
Registration Member/Non-Member can attend this session. The session is on a first-come first-served basis and is
limited to 150 people)
I will attend the Cardiothoracic Nursing Course on May 14, 2015
1
To be eligible for the trainee / nurse & perfusionist rates, trainee / nurse & perfusionists are required to produce documentary evidence of
their status. Without this documentation, non-member fees will be applied. You may send necessary document by fax at +90 212 347 63 63
or via e-mail to [email protected] .
2
Only one course can be selected since all courses are on May 11, 2015 at the same time except Cardiothoracic Nursing Course on May
12-13, 2015.
3
CWIG Gala Dinner is free of charge for those who register as CWIG Member/Non-Member. Those who register as all other registration
types should pay USD 125 per person.
Delegate Fees (for CWIG Registration) include:
Delegates are entitled to access to all scientific sessions of meeting of Chest Wall International Group, live
surgery demonstration on May 15, 2015 and all scientific sessions of ASCVTS Annual Meeting (except AATS/ASCVTS
Postgraduate Courses)
Entrance to exhibition area
Congress bag and printed materials
CWIG Gala Dinner on May 14, 2015
Coffee breaks to be served during the congress scientific program and live surgery demonstration on May 15, 2015
Please fill in this form and send it to: DEKON CONGRESS & TOURISM
Gayrettepe Mah. Yıldız Posta Cad. Akın Sitesi 1. Blok No: 6 Kat: 1 D: 3 34349 Beşiktaş – Istanbul – TURKEY
Phone: +90 212 347 63 00 Fax: +90 212 347 63 63 E-mail: [email protected]
REGISTRATION FORM
Shuttle bus service to Queen Elizabeth Hospital from major hotels on May 15, 2015
Shuttle bus service from Queen Elizabeth Hospital after live surgery demonstration to Hong Kong International
Airport *, major hotels and for half day ciry tour **
* For those who leave Hong Kong by flights after 5 pm on May 15, 2015
** Half day city tour – self paid social event (details to be announced later)
Delegate Fees (for ASCVTS Registration) include:
Except for those who register to the AATS/ ASCVTS Postgraduate Course only, delegates are entitled to access
to all scientific sessions of ASCVTS Annual meeting and meeting of Chest Wall International Group (except live surgery
demonstration on May 15, 2015)
Entrance to exhibition area
Congress bag and printed materials
Coffee breaks to be served during the congress scientific program (except live surgery demonstration on May 15,
2015)
Welcome Cocktail on May 11, 2015
Course Fees include:
Course attendance
Coffee breaks to be served on May 11, 2015
Accompanying Person Fee includes:
Welcome Cocktail on May 11, 2015
Full Day City Tour on May 12, 2015
Entrance to exhibition area
Cancellation Policy – Registration:
Requests for registration cancellation must be received in writing by the ASCVTS / CWIG 2015 Registration Secretariat
(DEKON) by fax at +90 212 347 63 63, or via e-mail to [email protected] .
Cancellations received before or on March 17, 2015 – eligible for 50% refund
Cancellations received on or after March 18, 2015 – no refund
Please note that registration refunds will be processed within 30 days after the end of ASCVTS / CWIG 2015, bank
charges will be deducted from the refund.
Accommodation Information
Hotel
Renaissance
Harbour View Hotel
Category
Distance to the Congress Venue
Room Type
5 Star
1 min walking
Standard
Single Room
Double Room
USD 280
USD 280
Please make your reservations early; bookings are on a first-come first-served basis.
For any queries about hotel matters, please contact us via email: [email protected]
Rates quoted are in USD, per room per night, excluding breakfast and 10% service fee, including wifi.
Deadline for hotel reservations is April 1, 2015. For reservation requests after that date, Dekon may not be able to guarantee any
available rooms with the above-mentioned room rates.
Room reservations will be confirmed only after receiving full payment with credit card or by bank transfer.
Hotel check-in time is 15:00 hrs and check-out time is 11:00 hrs. If you expect to arrive earlier than the check-in time and require
guaranteed check-in on arrival, please make your hotel reservations for the day before.
Please Reserve:
Check-In:
/ 05 / 2015
Check-Out:
/ 05 / 2015
Total Number of Nights:
Single Room : …….. Room(s) X
USD …………………… (Price) X
………. Nights =
€ ………………….. (Total cost)
Double Room: …….. Room(s) X
For double rooms, please select:
Sharing the room with:
USD …………………… (Price) X
French bed (one big bed)
………. Nights =
€ ………………….. (Total cost)
Twin bed (two single beds)
Accompanying Person: …………………………………………………………………………………………………………………
Another Participant: …………………………………………………………………………………………………………………….
Please fill in this form and send it to: DEKON CONGRESS & TOURISM
Gayrettepe Mah. Yıldız Posta Cad. Akın Sitesi 1. Blok No: 6 Kat: 1 D: 3 34349 Beşiktaş – Istanbul – TURKEY
Phone: +90 212 347 63 00 Fax: +90 212 347 63 63 E-mail: [email protected]
REGISTRATION FORM
Special Requests, if any:
Accommodation Total:
Cancellation Policy – Accommodation:
Cancellations or changes should be received in writing by the ASCVTS / CWIG 2015 Registration Secretariat (DEKON) by
fax at +90 212 347 63 63, or via e-mail to [email protected] . Please do not contact the hotels directly.
Cancellations received before or on January 29, 2015 – eligible for full refund, less one night deposit
Cancellations received on or after January 30, 2015 – no refund
Please note that accommodation refunds will be processed within 30 days after the end of ASCVTS / CWIG 2015,
bank charges will be deducted from the refund.
In the event of non-arrival, the hotel will automatically release the reservation and full payment will be non-refundable.
Late arrival /Early Departure Fee - If you arrive later or leave earlier than on the dates of your confirmed booking, the total
cost of accommodation will be charged and no refunds will be issued.
Airport Transfer Information
One way private transfer fee
:
USD 125 / per car (max 2 people)
: ……………………..
Arrival Flight No
: ……………………..
:
/ 05 / 2015
Arrival Time
Departure Date:
/ 05 / 2015
Departure Time: ……………………… Departure Flight No : ……………………..
Arrival Date
: ………………………
Number of car(s)
Airport Transfer Total:
Rates quoted are in USD, for one way.
Drop off and pick-ups will be made to/from hotel.
Cancellation Policy – Transfer:
Cancellations or changes should be received in writing by the ASCVTS / CWIG 2015 Registration Secretariat (DEKON) by
fax at +90 212 347 63 63, or via e-mail to [email protected] .
Cancellations received before or on April 29, 2015 – eligible for full refund
Cancellations received on or after April 30, 2015 – no refund
Please note that transfer refunds will be processed within 30 days after the end of ASCVTS / CWIG 2015, bank
charges will be deducted from the refund.
GRAND TOTAL : € …………………
I ACCEPT THE GENERAL CONDITIONS FOR REGISTRATION, ACCOMMODATION & TRANSFER
Please fill in this form and send it to: DEKON CONGRESS & TOURISM
Gayrettepe Mah. Yıldız Posta Cad. Akın Sitesi 1. Blok No: 6 Kat: 1 D: 3 34349 Beşiktaş – Istanbul – TURKEY
Phone: +90 212 347 63 00 Fax: +90 212 347 63 63 E-mail: [email protected]
REGISTRATION FORM
Payment Information
Payment by Wire Transfer:
For payment by wire transfer, please use the following bank account:
Account Name
Bank Name
Branch Name / Code
Swift No
IBAN No (USD)
DEKON Kongre ve Turizm
T.Garanti Bank – Istanbul – Turkey
Esentepe Branch / 347
TGBATRISXXX
TR81 0006 2000 3470 0009 0938 00
Bank charges are the sole responsibility of the participant and should be paid in addition to the fees.
All wire transfers should indicate the following information: “Name of Sender, Date of wire transfer, Amount of wire transfer &
Explanation” and receipts must be sent by fax to DEKON at: +90 212 347 63 63, or by e-mail to: [email protected]
Payment by Credit Card:
Credit Card Number:
Expiry Date:
Card Verification Code:
Last 3 digits at the back of your card, on the signature panel
Cardholder’s Name:
Date:
Cardholder’s Signature:
You may also register and pay using our online registration form on the official website
www.ascvts2015.org
Please fill in this form and send it to: DEKON CONGRESS & TOURISM
Gayrettepe Mah. Yıldız Posta Cad. Akın Sitesi 1. Blok No: 6 Kat: 1 D: 3 34349 Beşiktaş – Istanbul – TURKEY
Phone: +90 212 347 63 00 Fax: +90 212 347 63 63 E-mail: [email protected]