Registration Form

Please submit one form per person!

^*indicates obligatory field

Title*:  ---Ms.Mrs.Mr. Degree:  ---Dr.Prof. Last name*:  First name*:  Middle initial(s):  Department:  Institution:  Address*:  Postal or ZIP code + city*:  Country*:  Phone:  Fax:  E-mail*:  Registration fee: before March 17, 2006      after March 17, 2006                     on-site   Members 300 EUR      350 EUR 400 EUR   Non-Members 350 EUR      400 EUR 450 EUR   Student 100 EUR      100 EUR 150 EUR   Africa/Eastern Europe 150 EUR      200 EUR 250 EUR   Accompanying persons 80 EUR      80 EUR 80 EUR Registration fee includes all congress material, lunches, welcome reception and beach volleyball tournament. The registration fee depends on the date of payment. Gala Dinner (30 EUR per person):   I will attend with    additional persons Pre Congress Hands On Workshop (50 EUR)   I will attend the workshop  Porcine liver transplantationAll about genomics and proteomics for the surgeon Total amount: .00 EUR (calculated automatically by JavaScript) Payments to: Subject:  99 22 87 Bank:  Hypo Vereinsbank AG, Filiale Rostock Bank code:  200 300 00 Account no.:  1955 1515 IBAN:  DE66 2003 0000 0019 5515 15 SWIFT-BIC:  HYVEDEMM300 Note: Advanced booking is highly recommended. Participants of the congress are encouraged to order their accommodation before March 17, 2006 for the special rate "essr2006" Hotel Neptun       single bed room EUR 120 per night Seestr. 19       double bed room EUR 182 per night 18119 Rostock-Warnemünde, Germany phone +49 381 777 7777 fax +49 381 777 800 info@hotel-neptun.de Booking link: http://www.hotel-neptun.de/pages_english/eng_uni.html (Please put "essr2006" in the "special wishes or comments" field!)