Registration form
 I register d e f i n i t e l y for the IV. International Symposium "Age-Related Macular Degeneration"
 
Social events:
 Guided Tour + Museum (Friday)      person/-s
 Social Event and Dinner (Friday)      person/-s
 Casino Baden-Baden (Saturday)      person/-s
 
I am a:
 Specialist
 Resident*
 Student*
(*Certification required! Please fax to 02 11 / 59 35 60
 
Payment must be made in advance:
 Bank transfer to the
     Stadt-Sparkasse Duesseldorf,
     Sorting code 300 501 10,
     Account number 100 457 4032,
     Congress-Organisation Gerling GmbH
     IBAN: DE91 3005 0110 1004 5740 32
     SWIFT-BIC: DUSSDEDDXXX
     Code word: AMD Baden-Baden,
     *Name of the participant*

 Eurocard, MasterCard
 American Express
 VISA Card
     Card no:     Valid: 

     Warning: The data will be submitted unencrypted.
     It cannot be excluded that other persons can get access to this data!!!!
 
Title, Mr. / Mrs.:  
Name, First name:  
Institute:
Institute address:
Zip code, Town:  
Country:
Fax:
Phone:
Email:
 

 
Arrival date:
Departure date:
Please tick: Single room (SR)     Double room (DR)
 
Hotels
(as printed or same category):
Dorint Sofitel
Maison Messmer *****
(approx. 3 min. walking distance)
www.dorint.com
SR: € 172,-
DR: € 218,-
incl. breakfast buffet.
Add € 1,40 health resort tax p.p
Reservation deadline:
25th July 2007
Steigenberger
Europäischer Hof ****
(approx. 3 min. walking distance)
www.steinberger.de
SR: € 130,-
DR: € 190,-
incl. breakfast buffet.
Add € 1,40 health resort tax p.p.
Reservation deadline:
25th July 2007
Holland Hotel
Sophienpark ****
(approx. 5 min. walking distance)
www.holland-hotel-sophienpark.de
SR: € 180,-
DR: € 240,-
incl. breakfast buffet.
Add € 1,40 health resort tax p.p.
Reservation deadline:
25th July 2007
Romantic Hotel
"Kleiner Prinz" ****
(approx. 1 min. walking distance)
www.derkleineprinz.de
SR: € 150,- - € 175,-
DR: € 199,- - € 275,-
incl. breakfast buffet.
Add € 1,40 health resort tax p.p
Reservation deadline:
5th March 2007
Hotel Bayerischer Hof ***
 
(approx. 10 min. walking distance)
www.hotel-bayrischerhof.de
SR: € 80,-
DR: € 110,-
incl. breakfast buffet.
Add € 1,40 health resort tax p.p.
Reservation deadline:
6th August 2007
 
First
choice:		  
Dorint Sofitel Maison Messmer
Steigenberger Europäischer Hof
Holland Hotel Sophienpark"
Romantic Hotel "Kleiner Prinz"
Hotel Bayerischer Hof		  
Second
choice:		  
Dorint Sofitel Maison Messmer
Steigenberger Europäischer Hof
Holland Hotel Sophienpark"
Romantic Hotel "Kleiner Prinz"
Hotel Bayerischer Hof
 
Special request:		  

 
 
 
Service and VAT (value added tax) are included in the room rate.
The rooms will be confirmed by Congress-Organisation Gerling GmbH, Duesseldorf, in order of their receipt. To guarantee your requested hotel, reservations should be made as soon as possible. Please do not reserve your hotel by phone. For cancellation and/or rebooking after confirmation an administration charge of € 17.00 will be made. In case of cancellation of the hotel reservation or if the participation is partly or fully cancelled after the indicated deadline Congress-Organisation Gerling reserves the right to charge up to 100% of the agreed accommodation price.
Werftstr. 23
D-40549 Düsseldorf
Fax: 0211 - 59 35 60