18th International
Course in Modern Rhinoplasty Techniques
and Facial Plastic Surgery
17-19 May, 2012
("regform18.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 650 - with dissection
( ) EUR 450 - without dissection
Please send the completed registration form by mail or fax to:
Attn. Dr.
Tamás Járai or
Secretary: Zsanett Pólicsné
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
+36 72 507-321
E-mail: ent.titkarsag@kk.pte.hu or pytelj@t-online.hu
WEB: http://ent.pote.hu/course18.htm