Capita Selecta Duikgeneeskunde AMC: Mini-Congress Diving Medicine 24 Sept – 1 Okt 2016

Capita Selecta Duikgeneeskunde

Mini-CongressDiving Medicine Malta

Fees

The course, lasting a week and offered by the CSD-AMC, carries these fees:

Meeting Fees
Physicians€ 390,- / Accreditation fees: NVD / € 45,-
NVAB / € 95,-
Non-Physicians€ 225,- / VSG / € 0,-
Else 1) / € 45,-
NICDA / € 45,-
1) Education outside own field

Included are: syllabus, course certificate and hot drinks offered during breaks in the proceedings

These fees are based on the organising costs of the mini congress by the CSC.

Due to the many advance payments CSD has to make, we are compelled to make the course fees forfeit.

Travel and accommodation costs (all inclusive, incl. local alcoholic beverages, per person) *)**)

Packages: choose the viewfrom therooms (A t/m L)

(7 nights, all inclusive, direct flights Schiphol/Malta return and transfers from and to airport Malta)

Double room, per person,
view: * / Single room
view: *
Flight & Hotel / A:
land view / B:
pool view / C:sea / D: land view / E:
pool view / F:
Sea
1038 / 1076 / 1105 / 1293 / 1332 / 1360
Double room, per person,
view: * / Single room
view: *
Hotel only / G:
land view / H:
pool view / I:
sea / J: landview / K:
pool view / L:
sea
654 / 691 / 720 / 905 / 944 / 972

Only registering for the mini-congress (no hotel, no flight): fee according to the table “Meeting Fees”

Bookingfee:€ 30,- per person

*) Depending on availability.

**) Please note that in general airline tickets will be more expensive closer tothe departure date. All fees are subject to change and will be adjusted until the moment that full payment is received.

Divingpackages

About divingpackages (4 or 5 days) further information will follow.

Fees will most likelyamount to about €30,-/day.

Also on boat diving and dive trips to Gozo and Comino we will inform you later.

Registration form

Please fill out identically as mentioned in your passport! / Please fill out electronically
First name
Surname
Male/Female
Date of birth
Street and house number
Postal code and City
Country
E-mail address
Telephone
Cell phone
Telephone (ice)
Specialisation*
Affiliation *
BIG number*
Accreditation
NVAB € 95 * / Yes/No
NVD€ 45 * / Yes/No
VSG€ 0* / Yes/No
Education outside own field€ 45 * / Yes/No
NICDA€ 45 * / Yes/No
Are you sharing a room with another course member? / Yes/No
If so, with whom?This participant needs to fill out his/her own form.
Are you sharing your room with someone who is not participating in the course? / Yes/No

All fields must be completed except for those marked with * when one is not a physician

Registration form for a introduced roommate** (non-course member)

Please fill out the same as mentioned in your passport! / Please fill out electronically
First name
Surname
Male/Female
Date of birth
Name of roommate ( who is a course participant)
E-mail address

**Introduced guest in a separate room?Please fill out a separate form.

Registration form continued

Please complete this calculation electronically

Participant

Booking fee€ 30,-

Course fee€

Accreditation add-on(s)€

Travel accommodation packet: room location (A to L) €

Business class: prices on request by CSD€

Roommate (non-participant)

Booking fee€

Travel & accommodation packet: same as participant€

Business class: prices on request by CSD€

+

Total Sum (add)€

I agree to the conditions and the total amount due and I agree to pay an advance of€ 600 for participating physicians, € 450 for all other participants and € 250 for non-participants, due immediately and the remainder as soon as you receive our invoice.

NB thecourse participant signs for his/her roommate as well, if this person is a non- participant.

After 1 July 2016 the total sum is immediately due. Be aware that after 1 July2016 costs could be significantly higher than mentioned here.

Date………………………....Name ……………………………………………

(Electronic) Signature: ………………………………………………..

  • Please send this form to:
  • electronically to Eduard van Riet Paap, .
  • Payments to:
  • ING accountNL05INGB0005856014 of theStichting Duik Research at Aerdenhout, the Netherlandsunder the mention of Malta. BIC code (SWIFT code) of the ING Bank is INGBNL2A.

Conditions

All bookings occur under the conditions of the Dutch ANVR: ( for the total amountwith the exception of the course and accreditation fees, as these are forfeit.

  • Flight and roomreservations are made on a basis of availability
  • All changes in prices and exchange rates of, but not excluded to, airlines, hotel, governments etc will be charged until the moment full payment is received.
  • In case of cancellation within 7 days after datestamp of this registrationform, full restitution will be made except for the booking fee. Cancellations must be made by registered mail addressed to N.A.M. Schellart (BMP&E, bouwdeel L-0, AMC. Postbus 22660, 1100 DD, Amsterdam.).
  • This offer is subject to the jurisdiction of the courts of the Netherlands.