Philipps-Universität Marburg
NanoBionics III - from Molecules to Applications
April 4-8, 2005 / Marburg - Rauischholzhausen (Germany)
Registration Form
To be returned by January 17, 2005
First Name, Surname
Mrs
Mr
Academic Title
Institution/Company
Department/Division
Address/Street/POBox
Zip/City/State
Phone
Fax
E-mail
Accompanying person(s):
(number)
Arrival at Marburg:
Sun, April 3, 2005
Mon, April 4, 2005
other time (approx.):
Arrival by:
car
train
air (Frankfurt)
Departure Marburg:
Fri, April 8 / after lunch
other time (approx.):
Accomodation
Registrant
Accompanying person
(sharing double room)
Extra day
(single/double)
Guest house
(incl. breakfast)
fully booked
Hotel***
(incl. breakfast)
fully booked
Hotel****
(incl. breakfast)
Euro 680
Euro 230
Euro 100/120
Hotel*****
(incl. breakfast)
Euro 880
Euro 310
Euro 150/190
Only a limited number of rooms are available in the guest house and in hotel***.
Registrant:
Price includes access to the conference, conference material, full board accommodation (beverages not incl.) for four (4) nights April 4-8, 2005, and excursion.
Accompanying person:
Accommodation (sharing the room with the registrant) and excursion.
Earlier arrival or later departure may be arranged at extra costs payable directly at the hotel/guest house.
Once you have been notified on the acceptance of your registration we kindly ask you to transfer your total costs to our bank account as soon as possible latest by February 28
th
, 2005.
Bank account owner:
Dr. Frank Noll SK
Keyword:
NanoBionics III
Bank:
Sparkasse Marburg-Biedenkopf
Universitätsstr. 10
D-35037 Marburg
Account number:
1013021542
Bank code:
53350000
IBAN:
DE95 533 500 00 1013 021 542
BIC:
HELA DE F1 MAR
(Transfering fees to the debit of the registrant)
Contribution:
Oral Presentation *
Poster Presentation *
Conference Attendance
Title of your contribution:
Special remarks:
*Please do not forget to send your abstract to
abstracts@nanobionics3.de
.