2Nd World Congress of Clinical Safety

Offline Registration 2nd World Congress of Clinical Safety - Risk in Clinical Care- (Bank transfer) form By International Association of Risk Management in Medicine (IARMM) 12th (Thus) - 13th (Fri) September, 2013 Heidelberg University, Heidelberg, Germany

Registration deadline: 31th August, 2013 After you fill this registration form, fax it to the following registration office (+81-3-3817-6770).

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A. Registration fee This registration is not valid before our confirmation of your payment. Please mark ㇾ at your choice. IARMM non-member IARMM member and Price Student Price

Delegate Fee Thursday 12th & Friday 13th September 2013 ( ) euro 300 ( ) euro 220 (The price is tax free.)

Delegate Fee Thursday 12th September 2013 ( ) euro 150 ( ) euro 110 (The price is tax free.)

Delegate Fee Friday 13th September 2013 ( ) euro 150 ( ) euro 110 (The price is tax free.)

Dinner Ticket ( ) euro 65* ( ) euro 65* (not included in any package, *price includes VAT) * If your trust or organisation are not paying for your dinner ticket you should register as a delegate to receive your invoice for the delegate registration only and you can then register separately for your gala dinner tickets to receive a separate invoice. (Term condition) On a case of cancellation, registration fee is not refunded. When a delegate replaces with another person, email the request to the following office. B. Hotel accommodation Followings are our recommendation for your search. http://www.soas.ac.uk/visitors/location/hotels/ http://www.soas.ac.uk/visitors/location/hostels/

Please note that URMPM in no way indorse these hotels or take responsibility for your booking with your chosen hotel. Your booking is a contract between yourself and your chosen hotel.

C. registration payment way

In a case of credit card payment, use our online payment system (PayPal Ltd) in the Congress homepage. http://www.urmpm.org/UWC2012/ . Only VISA or MASTERCARD are available. Your signature and password are not necessary. Don’t need to use this registration form.

In a case of bank transfer, send the following bank account. Bank name: Bank of Tokyo-Mitsubishi UFJ Branch name: Hongo Branch Branch number: 351 Account name: IARMM Account number: ０１１１７１９ Sift code: BOTKJPJT

(Note) For check use, you have to get an international check (Demand Draft) in your bank. Thus, instead of check payment, you should use the following bank transfer. We don’t accept any check.

------In a case of bank transfer payment, please fax this form to the following office till the registration deadline. And, fax a copy of your receipt, too.

URMPM World Congress 2012 in London Administration Office c/o World Health Risk Management Center Union of Risk Management for Preventive Medicine (URMPM) (Tel / Fax) +81-3--3817-6770 (Email) [email protected] 4-7-12-102 Hong, Bunkyoku, Tokyo,113-0033, JPN