SASP

Joint Annual Meeting of the Scandinavian Association for the Study of Pain and the Danish Pain Society

19-21 April, 2012 at Radisson BLU Scandinavia Hotel in Aarhus

First name

Surname

Title

Company/institution

Department

Address

Postal Code

City

Country

Phone no.

E-Mail

Vegetarian

Vegan

Diabetic

Other

Registration fee

SASP

Early Registration before March 15th

Late Registration after March 15th

SASP member (trainee/ nurse)

DKK 2000

DKK 2200

SASP member (regular)

DKK 3000

DKK 3400

Non SASP member (trainee/ nurse)

DKK 2500

DKK 2700

Non SASP member (regular)

DKK 3500

DKK 3900

Company representative

DKK 3500

DKK 3900

SASP - additional conference day - (scientific programme Saturday after lunch)

DKK 500

Social programme

Mayor's welcome reception at The Concet Hall Aarhus Thursday 19th at 19:00 (incl. in the registration fee)

Yes please, I would like to participate

No thank you, I am not able to participate.

Conference dinner at FRÜD Friday 20th at 19:00 - DKK 700 per person

Yes please I'll like to participate DKK 700

No thank you

Total

DKK

Payment

Transferred to ”SASP”, c/o KongresKompagniet, S.W.I.F.T. DABADKKK, account No. 3643 3632584598, Danske Bank, Holmens Kanal 2-12, DK-1092 Copenhagen K, Denmark. PLEASE state name and “SASP”. IBAN: DK33 3000 3632 5845 98

By credit card (please have your credit card ready for online payment)

Electronic invoice (for Danish participants only).

EAN

Accommodation

To obtain the stated room prices you must book through the conference secretariat KongresKompagniet by filling in and submitting this form.

Payment directly to the hotel upon departure. All room prices are per night per room and includes VAT, service charges and breakfast.

Arrival

Departure

I wish to share a double room with

Comments

The registration form is sent to:
KongresKompagniet – Nordhavnsgade 4 – DK-8000 Aarhus C - CVR-nr: 3216 1588
Phone: +45 8629 6960 – Fax: +45 8629 6980
E-mail: sasp@kongreskompagniet.dk