Online Registration Form 19th International LDDR - Geneva, Switzerland - 02 - 04 February, 2012

First Name		Last Name
Title	Mr Ms
Company		Functional Title
Address
City
State/Province		Work Phone
Zip/Postal Code		FAX
Country	Other (specify in address lines) Algeria Andorra Australia Austria Belgium Bulgaria Canada Cyprus Czech Rep Denmark Finland France Germany Greece Hungary Ireland Italy Japan Kenya Luxembourg Malta Morrocco Netherlands Norway Portugal Russia Spain Sweden Switzerland Tunisia United Kingdom United States	E-mail

REGISTRATION AND ACCOMMODATION

Early registration fee (until 14 December, 2011):	CHF 1,980
As from 15 December, 2011, :	CHF 2,080
Reduced registration fee for one submitting author for each accepted abstract:	CHF 1,780

Hotel:	Mandarin Oriental Geneva Quai Turrettini, 1201 Geneva, Switzerland
Fee Includes:	Hotel accommodation - five stars - for 2 nights ( 02 & 03 February, 2012), lunches, course dinner with transportation, registration and course material.
Conditions and Cancellations policy:	Confirmation letter will be sent only after payment of the total amount of registration. Deadline for registration and hotel cancellation is 14 December, 2011.  After this date, no refund can be made
Fee for additional nights including breakfast and taxes:	Single room :     CHF 460 per night Double room:     CHF 510 per night
* I will share my accommodation with:
Arrival  Departure Number of nights Select 01 February 02 February 03 February Select 02 February 03 February 04 February 05 February 06 February

PAYMENT

Bookings will be confirmed upon receipt of the payment. The total amount will be paid including additional nights using
Credit Card or  Bank Transfer:	Select one Bank Transfer Visa MasterCard American Express
Cardholder Name
Card Number
Expiry Date
Control digit
Billing Address
Bank transfer to      World Avenues S.A. Bank     Credit Suisse,  CH-1211 Geneva 70 IBAN     CH23 0483 5046 9213 6100 1 Account     469213-61-1  LDDR Clearing     4835 Swift  CRESCHZZ12A
Modifications are accepted in writing only (via fax: +41 22 906 9410 or via email: lddr@world-avenues.com) and  must be notified to World Avenues SA and not to the hotel directly
REMARKS

You will receive a registration receipt confirmation message at the email address you indicated above  from World-Avenues SA lddr@world-avenues.com. Another message should follow to confirm  your payment as well as your hotel reservation.

Download a printable version in the format "Adobe Acrobat":  Registration Form (you may use the right mouse button and select "Save target as" or "Print Target").

Should you not have the necessary software to open the file, you may download  for free \u2013 the Adobe Acrobat Reader from ADOBE.