REGISTRATION FORM

I N T E R N AT I O N A L    W O R K S H O P    O N    D I A G N O S T I C
A N D
T H E R A P E U T I C    D I G E S T I V E    E N D O S C O P Y
Budapest - Hungary

14 September (Friday, 8.40-18.00) -
15 September (Saturday, 8.30-17.15) 2012

RE G I S T R AT I O N    FO R M
(Fax: + 36 1 365 1668 or online registration: www.agnusmed.hu)

Participant's Details

Title:                     

City:       

First Name:         

Country:

Family Name:      Phone:  
Mailing address: Fax:       
Postal code:        E-mail:  
Address of invoice, if it is not the participants name and address:


 
Registration Fee
until 15.06.2012
after 15.06.2012
Doctors
200 €
250 €
Individual ESGE members
150 €
200 €
Doctors under 35 years
120 €
150 €
Nurses
100 €
120 €

On site registration possible on Friday 14 September 2012 from 08:00 to 18:00 and
Saturday 15 September 2012 from 08:00 to 14:00. Additional charge 20,00 EUR

Gala dinner (14 Sept.)
40 €/person

Danubius Hotel Helia - Budapest
(not far from Military Hospital)
Single room 100 € / person / night
Double room 120 € / room / night

Danubius Hotel - Arena - Budapest
(walking distance to venue)
Single room 90 € / person / night
Double room 110 € / room / night

Thursday (13 Sept.)
Friday (14 Sept.)
Saturday (15 Sept.)
Sunday (16 Sept.)

Payment Method
Please register online (www.agnusmed.hu).
After receiving your registration, we confirm it and send you
our bank account number.
After receiving your payment we send you the invoice.
In case you have an EU-VAT number please state below
in accordance with the EU invoincing rules.
EU-VAT Number: