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REGISTRATION print page
  PAUL MARTINI SYMPOSIUM 2006:
Pharmacotherapy for the critically ill patient in intensive care
Berlin, 17/18 November 2006


Registration
  (Participation in the symposium is free of charge.)
I herewith register for the Paul Martini Symposium 2006
Unfortunately, I cannot participate in the symposium.
 
Personal Information
Title
Name
First Name
Company
Street
ZIP Code / City
Country
Phone
Fax
E-Mail
 
ACCOMMODATION
*The Paul Martini Foundation will cover one accommodation expenses including breakfast. Double occupancy supplement and breakfast for accompanying persons will not be covered. In case of short term cancellation (3 days in advance) or no show, you will be charged the cancellation fees.

Mercure Hotel Berlin an der Charité
Invalidenstraße 38, 10115 Berlin
Arrival
Departure
Single Room
Double Room*
Non-smoker
Other
 
Social Events
Hörsaalruine des Berliner Medizinhistorischen Museums,
Schumannstr. 20/21, 10117 Berlin
I will attend the conference dinner on November 17, 2006 at 19:30 at the Hörsaalruine
(Attendance of the conference dinner is free of charge.)
 
Miscellaneous
I require a special diet
I am vegetarian
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