4th Scientific Meeting/Training School of the European GnRH Network

Only fields marked * are mandatory!

Prefix (Ms., Mrs., Mr., Dr. etc.)*
First name*
Middle initial
Last name*
Brief affiliation how it should occur on badge
Organization/Company*
Department
Address*
Address (City)*
Address (Country)*
Zip/Postal code*
Primary phone (Please enter your country code, area code and phone number with no dashes or spaces)*
Mobile phone (For emergency onsite use only)
Phone number of emergency contact
Fax (Please enter your country code, area code and Fax number with no dashes or spaces)
E-mail (Your e-mail is required to receive confirmation)*
Confirm e-mail*
Registration fees*
Will you be able to attend the Welcome reception on the 6th of March?*	Yes No
Complete billing address (as it should appear on the invoice)*
Select a payment method*	Bank transfer Credit card I am invited speaker
Other requests

PAYMENT INSTRUCTIONS
REGISTRATION WILL ONLY BE CONFIRMED UPON FULL PAYMENT.
PAYMENTS MUST BE MADE BY BANK TRANSFER OR CREDIT CARD WITHIN 3 WORKING DAYS, RESPECTIVELY. OTHERWISE YOUR CONFERENCE REGISTRATION WILL BE CANCELLED!
If a company/institution is paying for your costs, don’t forget to have them indicate your name in the memo so we can easily identify the payment.
PROOF OF BANK TRANSFER (SCANNED DOCUMENT IN PDF OR JPEG FORMAT) NEEDS TO BE E-MAILED TO finance@stand-art.hu within 6 working days.

BANK ACCOUNT DETAILS:
Account holder: Stand-Art Agency Ltd.
Office: H - 6723 Szeged, Tisza Palace B/2., Felső Tisza-part 31-34.
EU VAT Reg. Nr.: HU13970831
Bank Account: CIB Bank Zrt. (6720 Szeged, Kis Menyhert 1.)
SWIFT CODE: CIBHHUHB
IBAN: HU37 1070 0062 4857 8107 5000 0005
Registry Court Nr.: 06-09-011343

REFUND
Partial refund of registration fee (75%) will be provided for cancellation on or before 1^st March 2016; no refunds will be given after this date. E-mail requests to: finance@stand-art.hu. Subject: GNRH2016 Refund