Name: ________________________________________________________

Institute: ______________________________________________________

Address: ______________________________________________________

City: _________________________________________________________

Country: ______________________________________________________

ZIP code: _____________________________________________________

Phone: _______________________________________________________

Fax: _________________________________________________________

E-mail: _______________________________________________________

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

( ) DEM 750.00 - with dissection

( ) DEM 500.00 - without dissection

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

Attn.        Antalovicsné Boros Rita

Address:   Pécs University, Faculty of Medicine

                 Department of Otorhinolaryngology

                 Munkácsy M. u. 2.

                 Pécs, Hungary

                 H-7621

Phone/Fax: +36 72 312-151

E-mail: ent@ent.pote.hu

www: http://ent.pote.hu/course7.htm

Program

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