Online registration

The fields marked with * are required.

Personal data

Family name *

First name *

Institution *

Department

Postal code *

City *

Country *

Street *

Phone *

Fax

E-mail *

Accompanying Person Name(s)

I need official invitation letter for VISA purposes. (express mail fee: 30 Euro): yes no

Registration fee

Please.

Registration Type	Early Bird Fees Until 15 July, 2012	Regular Fees After 15 July, 2012
Pain Conference and Practical Workshop Workshop enrollment	1430 Euro	1600 Euro
Pain Conference	1000 Euro	1150 Euro
Hotel reservation only	-	-
Accompanying person fee	280 Euro	350 Euro

All prices are includes VAT.

Hotel Reservation Hotel Reservation is required: yes no

Prices indicated in EUR per room, per night, including breakfast and all taxes.

Please select the desired room type.

Hotel	Single Standard/Deluxe	Double Standard/Deluxe
Kempinski Hotel Corvinus Budapest*****	Fully Booked	Fully Booked
Hotel Central Basilica***	Fully Booked	Fully Booked

Arrival date *

Departure date *

Number of Nights

Please .

Special requests

I would like to share my room with

Hotel reservation will be made only on receipt of 2-night hotel deposit.

Optional program

Optional program	Price	Person(s)	Amount
Sightseeing tour in Budapest Monday, 3 September, 09.30-13.00	25 Euro (included in the accompanying person fee)		0 Euro
Awards Ceremony Dinner Tuesday, 4 September, 2012, 20.00-23.00	120 Euro (included in the registration fee)		0 Euro

All prices are including VAT.

Cancellation Policy

All the cancellations and changes must be sent to the Congress Organiser (CongressLine Ltd.) in written form. All refunds will be processed after the PAIN Conference. Please send your exact bank account details in the written cancellation.

Refund of the registration fee will be made as follows:

100% refund (minus an administrative fee of 50 Euro) – in case of cancellation, received before 15 July, 2012
No refund – in case of cancellation, received after 15 July, 2012

Refund of the hotel deposit sent to the Congress Organiser will be made as follows:

100% refund (2 night deposit) – in case of cancellation, received before 15 July, 2012
No refund (2 night hotel deposit will be charged) – in case of cancellation, received after 15 July, 2012

Refund of the dinner and optional tour will be made as follows:

100% refund – in case of cancellation received, before 15 July, 2012
No refund – in case of cancellation received, after 15 July, 2012

Payment

Payment	Total
Registration fee	0 Euro
Accommodation 2-night deposit	0 Euro
Optional program	0 Euro
Total	0 Euro

Payments should be made in advance by one of the following methods:

ATTENTION! For your security, CongressLine consults with the bank about the credit card data given, and your card will be charged only after a pre-authorisation process. (This manual process could take even one or two working days)

Please select your payment method!

Credit Card
Please charge EUR: 0 to my VISA EC/MC AMEX
Card number
Cardholder's name
Billing address of the Cardholder
Expiry date / MM/YY
CVC Code only VISA and EC/MC (the last three digits on the back of the credit card where the signature is):

Please note that our Office will debit your credit card in EUR.

Bank Transfer
Account Holder's Name CongressLine Ltd.
IBAN Number HU19 10404027 50504851 52551011
Bank K&H Bank Zrt. (H-1051 Budapest, Vigadó tér 1. Hungary)
Swift Code OKHBHUHB
Please indicate 2012/14

All charges due to bank transfers have to be paid by the sender. The name and address of the sender have to be marked clearly on every remittance.

The Congress Bureau does not take any responsibility coming from the fact that the registration form is not readable or includes contradiction in the data provided.

Please send me an invoice in advance: yes no

Invoice/Receipt Details

Name/Company name * Address * Reference number/person

Please mark that you have read and accepted the cancellation terms.
I have read and accept the cancellation terms as contained within the official website.