<p> 5th PAN Arab Osteoporosis Congress April 28-30, 2010 Four Seasons Hotel-Damascus, Syria</p><p>R e g i s t r a t i o n F o r m</p><p>Full Name...... </p><p>Title ...... Specialty...... </p><p>Institution...... Nationality...... </p><p>Address...... </p><p>...... </p><p>Phone...... Fax...... </p><p>Mobile...... E-mail...... </p><p>Registration fees:</p><p>Syrian residents: 5000 Syrian Pounds Non-residents: 200 US$</p><p>Guest package which includes accommodation +breakfast, registration fees and Gala dinner: (Please tick your choice)</p><p>3 nights Four Seasons Hotel Package, April 27-30, 2010: US$ 1,400 2 nights Four Seasons Hotel Package, April 28-30, 2010: US$ 1,100 1 night Four Seasons Hotel Package April 29-30, 2010: US$ 800</p><p>3 nights Dedeman Hotel Package, April 27-30, 2010: US$ 1,100 2 nights Dedeman Hotel Package, April 28-30, 2010: US$ 900 1 night Dedeman Hotel Package April 29-30, 2010: US$ 700</p><p>Accompanying Person</p><p>Full Name:...... </p><p>Prices for Accompanying Person inclusive of all taxes and service charges:</p><p>Gala Dinner: US$ 75 Sharing a double room with attendee per night, including breakfast: US$ 50 Airport Pick-up in the same car with registered attendee: US$ 25</p><p>5th PAN Arab Osteoporosis Congress April 28-30, 2010 Four Seasons Hotel-Damascus, Syria</p><p>Total amount to be paid in US$ ...... </p><p>Payment should be made by credit card.</p><p>•Type of credit card:...... </p><p>•Credit card number:...... </p><p>•Expiration date:...... </p><p>•Name as it appears on the credit card: ...... </p><p>This form should be fully filled and e-mailed to: [email protected]</p><p>N.B: Accommodation requests must be sent before March 30th 2010, after which date we can no longer guarantee accommodation.</p><p>• All registrations are based on first come - first served basis. • No registration will be handled without the registration form duly completed • The hotels listed above will not accept direct reservations at the special congress rates.</p>