Mailing address:
4th Hungarian Conference on Alzheimer’s
Disease and Related Disorders
Administrative Secretariat
AKTIV TOURIST
H-6701 Szeged, POBox: 815, Hungary
 
REGISTRATION & PAYMENT
            (Please type or use block letters)
PARTICIPANT
Prof/Dr/Mrs/Ms/Mr............................................................................................................ 
Family name:............................................ First name:....................................................... 
Institute:............................................................................................................................ 
Mailing address:................................................................................................................. 
Postal code:......................City:.........................................Country:.................................... 
Telephone:........................Fax:................................E-mail:................................................
ACCOMPANYING PERSON/S:
Mr/Ms...............................................................................................................................
Family name:....................................................First name/s...............................................

REGISTRATION FEE 
Paid:
before 15 August, 1998
after 1 October, 1998
Participant:
150 USD
200 USD
Accompanying person/s
75 USD
100 USD
 
REGISTRATION FEE:.........................................................................................USD
ACCOMPANYING PERSON REGISTRATION:...............................................USD
HOTEL DEPOSIT:...............................................................................................USD
TOTAL FEE:.............................................................USD
METHOD OF PAYMENT All payments must be made in USA Dollars (USD):
1. Payment should be made in advance by bank transfer to:
    AKTIV TOURIST, Szeged  SWIFT MKKB HUHB 10300002 28514633 00003285

2. We do accept the Banker’s Draft (money order). The Banker’s Draft should be purchased at your bank made out in USD to: “AKTÍV TOURIST, SZEGED”. We regret that we are unable to accept any personal or company cheques. The Banker’s Draft should be sent together with the Registration Form to: AKTÍV TOURIST, H-6701 Szeged, POBox: 815, Hungary.

3. Holders of American Express Cards may use their cards for registration.
I authorize the AKTÍV TOURIST, Szeged MKKB HUHB 10300002 28514633 00003285   to debit my American Express Card for the amount of

                                     .....................USD (+5% service charge is applied)
 
Holder’s Name:...................................... No: _ _ _ _  _ _ _ _  _ _  Exp.:MM/YY:  - - - -
Holder’s billing address:......................................................................................................
Date:........................................................           Signature:...................................................

(Please return by Registered Mail before 15 August, 1998.)