A. PARTICIPANT's DETAILS - Please Fill in Capital Letters

Registration Booking Form A. PARTICIPANT'S DETAILS - please fill in capital letters Title: Prof. Dr. Mr. Mrs. Other Degree PhD M.D. Other *Surname: *First Name: *Institution: * Department: *Postal Address: *Postal Code: *City/State: *Country: *Telephone: Fax: *E-Mail: B. REGISTRATION EARLY FEE LATE FEE Registration Category Until August 31st, 2016 From September 1st, 2016 Full Delegate 300 € 350 €

C. ACCOMMODATION Please select the first, and Single Double Hotel Name second choice of the hotel: Room Room BEST WESTERN ILISIA HOTEL 80 € 85 € PRESIDENT HOTEL 85 € 90 € THE GOLDEN AGE OF ATHENS HOTEL 110 € 120 € Rates are quoted per room, per night including breakfast and all taxes.

Please complete the requested information in order to proceed with your reservation Date of Arrival: Date of Departure: Nights: No of Single Rooms No of Double Rooms

Additional Information (e.g. non-smoking room): D. PAYMENT IN EURO All payments should be made in EUR without charges for the beneficiary. Please note that late registration fees will apply for any payments received after the stated deadline. Confirmations of registrations and invoices for the relevant charges will only be sent after receipt of the appropriate fees. Outstanding payments must be paid on-site during the Conference.

By Bank Transfer ALPHA BANK EUROBANK Account Number: 103-002320-000855 Account Number: 0026-0237-83-0200937824 Swift Code: CRBAGRAAXXX Swift Code: EFGBGRAA IBAN Number: GR29 0140 1030 1030 0232 0000 855 IBAN Number: GR35 0260 2370 0008 3020 0937 824 Account Holder: Erasmus S.A. Account Holder: Erasmus S.A.

*It is important that a copy of the bank transfer receipt is sent to the Conference Organising Bureau by fax at +30 210 7257532 or by email at [email protected] along with respective Registration Form. E. CANCELLATION POLICY AND REFUND Cancellation of registration should be requested in writing to the Conference Organising Bureau. For every written cancellation received before August 10, 2016, 50% of the registration fee will be refunded. No refund will be issued thereafter. All refunds will be made within two months after the end of the Conference. Bank charges will be deducted.