Registration Form

Category


Personal Information (Please, fill application in English only)

Firstname
Surname
Birthyear
Main workplace / Organization
Department
Position
Work address
City
Zip/Postal code
Country
Email
Phone


Registration fees:

1. Registration for Plenary Session

Early registration
Up to and including 22 September, 2014

Late registration
from 23 September, 2014

On site registration

Doctor

60EUR

100EUR

120EUR

Special category*

30EUR

50EUR

60EUR

Student

20EUR

30EUR

40EUR



*Participant of Euromelanoma Georgia/Fellow/Family Doctor/Nurse
Proof of status for fellows and students must be sent together with registration to the Congress Secretariat at info@photoderm.org

Hands-on Course on Dermatologic Surgery - 50EUR
    This is supplementary course to the Plenary Session.
    Registration is allowed only for Specialists and Dermatology Fellows.
    Number of participants of this course is limited up to 40 persons
Registrations fee for plenary session includes: congress bag, attendance of all plenary sessions, workshops, symposia, CD with workshop materials, admission to the coffee breaks and lunches during congress days,
Certificate of Attendance

2. Registration for Course on Aesthetics
Registration is allowed separately without registration on the plenary sessions

Early registration
Up to and including 22 September, 2014

Late registration
from 23 September, 2014

On site registration

60EUR

100EUR

120EUR

Registrations fee for Course on Aesthetics includes: congress bag, attendance of Course, admission to the coffee breaks and lunches during Course, Certificate of Attendance.

Social events:
Gala dinner - 50EUR
Live music, Georgian National Dances
One day Wine tour - 70EUR
A full day tour with lunch and dinner


Payment Method

Payment of registration fees and other activities (in Euros/ GEL) can be made:

Bank Details for Transfer in EURO

Beneficiary: GEORGIAN ASSOCIATION OF PHOTODERMATOLOGY AND SKIN CANCER
Intermediary Bank: Commerzbank, Frankfurt, Germany; SWIFT: COBADEFF
Account With Institution: Bank of Georgia, SWIFT: BAGAGE22; 3, Pushkin Street, 0105 Tbilisi, Georgia
Account: GE63BG0000000495698000


საბანკო რეკვიზიტები ეროვნულ ვალუტაში (ლარი)

მიმღები ბანკი: სააქციო საზოგადოება "საქართველოს ბანკი"; ბანკის კოდი: BAGAGE22
მიმღების დასახელება: ააიპ საქართველოს ფოტოდერმატოლოგიისა და კანის კიბოს ასოციაცია
მიმღების ანგარიშის ნომერი: GE63BG0000000495698000

• Please ensure that the name of the meeting and of the participant is stated on the bank transfer.
• Bank charges are the responsibility of the participant and should be paid in addition to the registration fees.
Registration will only be valid upon receipt of the full payment by the registration department according to the deadline indicated. An email confirming registration will only be sent after receipt of the required fees.