1st Monographic Course Secpre 2018

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1^st Monographic Course Secpre 2018

Registration Form

PERSONAL DATA

*Mandatory data

*Surname:

*Name:

Department:

Hospital / Institute:

*Address:

*Zip code:

*City:

*Country:

*Telephone:

Fax:

*E-mail:

*ID or Passport:

REGISTRATION FEES

*Mandatory data

REGISTRATION FEE	Until 1/03/2018	From 2/03/2018

SECPRE MEMBERS	550 €	700 €

OTHER SURGEONS	950 €	1.050 €

SECPRE RESIDENTS *	375 €	500 €

OTHER RESIDENTS *	525 €	600 €

21% VAT included

The registration fee includes: documentation, attendance to the scientific sessions, coffee, lunches and official Dinners.

Deadline for registration is 26th May, 2018. After that date, both registration and payment will be made at the Course Venue.

(*) Resident doctors shall enclose a certificate signed by the Head of the Service. Participants not submitting the certificate will pay registration fee as SECPRE Member or as Other Surgeons.

Cancellation Policy:
• Changes and cancellations must be notified in writing to the Congress secretariat.
• Refunds will be made once the Course is over.
• Cancellations until 1/3/18 - Refund of 80%.
• Cancellations from 2/3/18 until 5/26/18 - Return of 50%.
• There will be no refund for cancellations after 5/27/18

TOTAL REGISTRATION FEE: Rellenar el formulario anterior.

PAYMENT METHOD

*Mandatory data

Transfer Credit card

Payments must be made in Euros to:

Fundación Docente SECPRE
CAIXABANK
C/ Clara del Rey, 31-33
28002 Madrid

Bank account: 2100 3918 82 0200191604
IBAN (electronic format): ES1621003918820200191604
IBAN (print format): IBAN ES16 2100 3918 8202 0019 1604
SWIFT / BIC: CAIXESBBXXX

(Please enclose copy of payment with your registration form)

Please send copy of payment to fax no. + 34 91 571 92 06 or enclose a file (JPG, GIF or Word format) by clicking in "Payment receipt

Remarks: Residents shall include a certificate signed by the Head of the Service.

Payment receipt:

CREDIT CARD

Once you have completed the form press: “SEND”. You will be directed to the bank payment gateway in order to complete your registration.

Rellene los siguientes campos para que nosotros podamos cargar el importe correspondiente a la tarjeta que usted nos indique.

*Tipo de tarjeta:

Eurocard

Master Card

Visa

American Express

*Nº de Tarjeta:

*Titular:

*Fecha de caducidad:

*CCC: (3 últimos números al dorso de la tarjeta)

PLEASE, FILL IN FOR INVOICE PURPOSES

Individual

Company

*Last Name:	*First Name:
*Passport number:	*Address for invoice:

YOU WISH TO BOOK ACCOMMODATION?

Yes No

OFFICIAL HOTELS

Hotel	Single Room	Double room

Hotel Nh Gijón ****	123,20 €	136,40 €

Hotel Abba Playa Gijón ****	132,00 €	143,00 €

Information

• All rates are per room and night including breakfast and 10% VAT.

• The official hotels are just at a ten-minute distance by car from the course venue. Transportation will be provided in the morning and at the end of the sessions, during the course days.

• Rooms will be allocated on a first-come first-served basis according to availability

• The number of rooms reserved at the mentioned prices is limited. It is recommended to make reservations well in advance in order to avoid last minute inconveniences.

• Reservations have been made from 31st May to 3rd June, 2018. Please check rates and availability with the Secretariat if you wish to extend your stay.

• Room rates nor room availability can be guaranteed after 25th March 2018. After that date, check availability and rates with the Secretariat.

• Contact the Secretariat for group reservations.

Payment

• All hotel expenses will be paid directly at the hotel upon check-out. The hotel will issue the corresponding invoice. Please note that the hotel is entitled to charge all the pre-booked nights.

• To secure your reservation your credit card guarantee is required. Please fill in the Credit Card Authorization form and send it by e-mail to Carlos Lazaro (c.lazaro@bnyco.com) together with a copy of your credit card and your ID or passport.

• In case of cancellation or no show, the hotel will charge your credit card the corresponding amount, according to the cancellation policy.

Written confirmation of your hotel booking with full address will be sent to you via e-mail once we have received all the documents dully filled. It should be presented to the hotel upon arrival.

Cancellation Policy

• All cancellations must be sent in writing to the secretariat.

• Cancellations notified prior to 30-12-2017 are free of charge.

• Cancellations made from 1-01- 2018 to 30-03-2018 will be charged with a cancellation fee equivalent to one night stay. This amount will be debited from your credit card at the moment of the cancellation.

• Cancellations made from 1-04-2018 to 5-23-2018 are charged with a cancellation fee equivalent to two nights stay at the hotel. This amount will be debited from your credit card at the moment of the cancellation.

• Cancellations made after 24-05-2018 will require the full payment for the reservation. This amount shall be debited from your credit card at the moment of the cancellation.

• No show, unexpected check-out, will require the full payment for the reservation, including taxes and fees.

ACCOMMODATION

*Mandatory data

*Hotel :

Hotel 2^nd option:
Hotel 3^rd option:

*Single Rooms:
*Double Rooms:
*Date of arrival:
*Date of departure:

Please select on the form: hotel, room reservation and dates of arrival and departure.

Information and Conditions for accommodation booking. See clause

I have read and accept the legal clause. See clause.

IMPORTANT: After pressing "SUBMIT", please wait a few minutes without pressing any other key, and without closing the page, until the "Successful Submission" message appears or go to the payment gateway to complete the registration if you have chosen "Payment by card".

SEND