13th International Course in Modern Rhinoplasty Techniques
and Facial Plastic Surgery

17-19 May 2007

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("regform13.rtf" Rich Text Format)

 

 University of Pécs Faculty of Medicine

Department of Otorhinolaryngology, Head and Neck Surgery

 

Registration Form

 

Name: ________________________________________________________

Institute: ______________________________________________________

Address: ______________________________________________________

City: _________________________________________________________

Country: ______________________________________________________

ZIP code: _____________________________________________________

Phone: _______________________________________________________

Fax: _________________________________________________________

E-mail: _______________________________________________________

 

On-site registration fee (please check one of the options):

( ) EUR 600 - with dissection

( ) EUR 400 - without dissection

 

Please sent the completed registration form by mail or fax to:

Attn.         Rita Boros

Address:   University of Pécs, Faculty of Medicine

                 Department of Otorhinolaryngology, Head and Neck Surgery

                 Munkácsy M. u. 2.

                 Pécs, Hungary

                 H-7621

Phone/Fax: +36 72 312-151

E-mail: boros@ent.pote.hu

www: http://ent.pote.hu/course13.htm