International Conference Communicating the Risk in Pharmacovigilance-Are We Going in The

REGISTRATION FORM

INTERNATIONAL CONFERENCE “COMMUNICATING THE RISK IN PHARMACOVIGILANCE-ARE WE GOING IN THE RIGHT DIRECTION?”

October 1 – 2, 2009, Zadar

Please complete the form and send it by e-mail () or fax (+385 1 4884 110) to the Agency for Medicinal Products and Medical Devices (attn. Mr. Armano Rajh).

The final deadline for registration is September 10, 2009.

REGISTRATION FEE / HRK 3,500.00 + VAT* = HRK 4,305.00

*From August 1, 2009 VAT rate is 23%

The registration fee covers all conference sessions and workshops, coffee breaks, two lunches, tourist tour of Zadar, Conference Dinner and Certificate of Attendance.

Registration and payment:

After registration, the registration fee can be paid solely on a basis of a proforma invoice, which participants can obtain from the office of the Agency for Medicinal Products and Medical Devices (Accounting Dept.) or have it delivered by mail/fax to the contacts designated in the registration form (please indicate how you wish to receive the proforma invoice for payment of the registration fee).

A copy of the payment order should be either e-mailed to or faxed to the following number: +385 1 4884 110, for the attention of Mr. Armano Rajh, no later than by September 15, 2009.

Cancellation Period
If unable to attend, registered participants should notify Mr. Armano Rajh (, fax: +385 1 4884 110), no later than September 23, 2009.

Cancellation

In case of cancellation or no-show, the cancellation/no-show charge will be calculated on the basis of the following schedule:

• in case of cancellation prior to September 23, 2009, the registration fee is fully refundable;

• after September 23, 2009, the Organisers retain 30%;

• no-show: the Organisers will retain 100 percent of the registration fee.

Accommodation

The registration fee does not cover accommodation costs. A certain number of rooms have been prebooked for conference participants in the hotels Kolovare and Falkensteiner Club Funimation Borik. If you wish to confirm the booking, please use the Accommodation Form which can be downloaded from the Agency website (www.almp.hr) and contact Obzor putovanja d.o.o. no later than September 15, 2009 at the address below:

Vladimir Mitić

Obzor putovanja d.o.o.

Teslina 5, 10000 Zagreb

e-mail:

Phone: +385 1 616 0242; Fax: +385 1 616 0240

For the participants staying in the Hotel Falkensteiner Club Funimation Borik there will be an organised bus service to Hotel Kolovare and back on both conference days.

Arrivals and departures

Each participant should make his or her own travel arrangements.

PARTICIPANT INFORMATION

(all fields are mandatory)

Name and family name:
Institution/Company:
Registration no. / tax no.:
Institution/Company address
City and zip code
Country
Phone:
Fax:
E-mail:
Arrival / date:
Departure / date:
I would like to receive the proforma invoice for payment of the registration fee:
(please underline the selected answer) / a)  by mail;
b)  by fax:
c)  I will pick it up personally from the Agency for Medicinal Products and Medical Devices

CONFERENCE DINNER

The conference dinner will take place on October 1, 2009.

I want to attend: YES

NO

(Please underline either YES or NO)

Note:

(If you prefer the vegetarian menu, kindly indicate so in advance.)

______

Signature of the registered participant