Name:

Family Name:

E-mail:

Phone number:

Institution:

City:

ZIP code:

Country:

Accomodation:

REGISTRATION AND ACCOMODATION

Registration fee:

50 Eur

From:

To:

Type of room:

SINGLE:

DOUBLE:

I will share my room with:

Hotel Bellevue ****

(F/B)

Hotel Metropol ****+

(F/B)

Payment:

Credit card:

Type of credit card:

Visa

Master Card

American Express

Number:

Expiry Date:

Name as shown on the card:

You may download

this application form

and send it to us by

fax.

Mobile phone:

Group registrations are accepted

Bank Transfer:

Albatros - Travels Skopje

Komercijalna Banka Skopje

IBAN MK07300701001823373

SWIFT KOBS MK 2X

or by...

Hotel Metropol (****+):

1/1 51 eur F/B ; 1/2 40 eur per person per night

Hotel Bellevue (****):

1/1 45 eur F/B ; 1/2 35 eur per person per night

OHRID, MACEDONIA

March 22-24, 2007

EUROPEAN SOCIETY OF ENDOCRINOLOGY (ESE)

3rd Postgraduate Course in Clinical Endocrinology