ACCOMPANYING PERSON REGISTRATION FORM (4th EPSMSO)

(for those who want only to attend the dinner of the Conference)

Accompanying person's details

Title:

Last Name:

First name:

Gender:

Position:

Organisation:

Address:

Country:

Phone:

Fax:

E-mail:

Event

Conference Banquet

65 EUR

Form of Payment

I have ordered a Bank Transfer* (copy of the bank transfer should be sent by e-mail)**

Payment by Western Union* (copy of the bank transfer should be sent by e-mail)**

Payment Date:

Sender Name:

* Bank/transfer costs are paid by the registrant
** Please indicate the name of the participant and the code "4th IC-EPSMSO Conference" and email to:
info2011 @ epsmso.gr

Receiving bank details:

Bank name and address:	NATIONAL BANK OF GREECE Galatsi Branch, Athens, Greece
Bank account number:	122/380098-93
Currency code	EURO
Code BIC (SWIFT address) (obligatory):	ETHNGRAA
COS IBAN:	GR7401101220000012238009893
Name of beneficiary:	PROFESSOR DEMOS TSAHALIS 4th IC-EPSMSO

Cancellation
All cancellation must be made in writing to the Conference Secretariat. For Cancellation received by 31 May, 2011
a refund of 80% will be granted. No refunds will be made for cancellations after that date.

Your registration will be confirmed after the receipt of payment (please don't forget to keep a copy for your file)

The conditions of this registration are hereby fully accepted.