Mrs Mr........................................................................................To be returned by 30 March 2000 to
| WE-Heraeus-Stiftung | Registration Form | |
| Heike Uebel | ||
| Postfach 1553 | Fax No. | |
| D-63405 Hanau | +49-6181-923-2515 | |
| Germany | ||
238. WE-Heraeus-Seminar / 10 - 14 July 2000 / Marburg (Germany)
NanoBionics - from Molecules to Applications
| First Name, Surname | Mrs Mr........................................................................................ |
| Academic Title | ..................................................................................................................... |
| Institution/Company | ..................................................................................................................... |
| Department/Division | ..................................................................................................................... |
| Address/Street/POBox | ..................................................................................................................... |
| Zip/City/State | ..................................................................................................................... |
| Phone | ..................................................... Fax...................................................... |
| ..................................................................................................................... |
| Accompanying person(s): | .................... (number) |
| Arrival at Marburg: | SUN, 9 July 2000 / afternoon / evening |
| MON, 10 July 2000 / morning (before 2:00 pm) |
|
| other time (approx.): .......................................................... |
|
| Arrival by: |
car |
| train |
|
| air (Frankfurt) |
|
| Departure from Marburg: | FRI, 14 July 2000 / after lunch |
| other time (approx.): .......................................................... |
| Accommodation: | Registrant | Accompanying person (accommodation in double room) |
Extra day (single/double) |
|
| |
Guest house (breakfast not incl.) |
DM 650,- | DM 220,- | DM 60,-/85,- |
|
Hotel*** (incl. breakfast) |
DM 850,- | DM 300,- | DM 90,-/140,- |
|
Hotel**** (incl. breakfast) |
DM 1.200,- | DM 350,- | DM 160,-/200,- |
| Registrant: | Price includes access to the conference, accommodation for four (4) nights 10-14 July 2000, lunch & dinner (beverages not incl.) and excursion. | |||
| Accompanying person: | Accommodation (sharing the room with the registrant) and excursion. | |||
| Earlier arrival or later departure may be arranged at extra costs payable directly at the hotel/guest house. | ||||
| Once you have been notified on the acceptance of your registration we kindly ask you to transfer your accommodation costs to our bank account as soon as possible latest by 30 April 2000. | ||||
| Bank account owner: | Wilhelm und Else Heraeus-Stiftung, Hanau |
| Bank: | Deutsche Bank AG Hanau |
| Account number: | 034566001 |
| Bank code: | 506 700 09 |
| Swift address | DEUT DE FF 506 (Transferring fees to the debit of the registrant) |
| Contribution: | Oral Presentation* |
| Poster Presentation* |
|
| Conference Attendance |
|
| Title of your contribution: | .................................................................................................... |
| .................................................................................................... | |
| .................................................................................................... | |
| Special remarks: | .................................................................................................... |
City / Date / Signature