European Society for Photodermatology

ESPD

Second European Photodermatology Course

16th – 17th May 2014

Ash Suite, Croke Park Conference Centre,

Jones Rd, Dublin 3

Registration Form

Please complete all sections of this form and return to:

Jacqui Carroll, Event Director, PO Box 11445, Fonthill, Lucan Co. DublinTel: +353 (0) 87 9629461

Email:

Section A: Delegate

Title: / Family Name: / First Name:
Address:
Tel: / Fax: / Email:
Hospital/Clinic Name:
Position:

Section B: Events

No. Persons

ESPD Course, Friday 16th May 2014 ____

ESPD Course Dinner, Friday evening 16th May 2014 ____

ESPD Course, Saturday 17th May 2014 ____

(Note: The cost of dinner in the Croke Park Hotel is included in the registration fee. Please indicate whether you wish to attend)

Section C: Registration Fees

Registration fee is €500 including VAT and covers cost of hand-outs, refreshment breaks and course dinner on Friday night . Payment information outlined in section D

Payment option (please tick one)

PayPal on web site course 

Cheque or Draft 

Section D: Payment

For PayPal payment please go to European Society for Photodermatology website photodermatology course and click on Buy Now button. If using PayPal option please ensure the email address you have supplied on registration form is the same as your PayPal one so payment can belinked to your registration.

For cheque payments please make cheque payable to European Society for Photodermatology and forward to:

Mrs Jacqui Carroll, Event Director, PO Box 11445, Fonthill, Lucan, Co. Dublin, Ireland

Section E: Dietary Requirements

Section F: Accommodation

Delegates must book their own accommodation

For Hotel reservations please contact the hotel directlyand quote “ESPD” for rate.

Bookings should be made before 4th April 2014 to ensure the negotiated rate. Bookings received after that date will be subject to availability at standard rack rates.

The Croke Park Hotel,
Jones Road,
Dublin 3

Tel + 353 (0)1 871 4551
Fax + 353 (0)1 871 4400

€129 Bed & Breakfast, Single per room, per night

€149 Bed & Breakfast, Double per room, per night

Registration/Cancellation Policy

Please note the following registration/cancellation policy, which will be strictly adhered to

.

  1. Cancellations received one month in advance of the meeting will receive a full refund
  2. Cancellations received two weeks in advance of the meeting will be refunded less an administration fee of 40%

4. Cancellations received less than one week in advance of the meeting will not be refunded.