Registration Form

6th International Course in Modern Rhinoplasty Techniques

June 1-3, 2000

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("Jellap6.doc" Microsoft Word for Windows95 ver. 7.0a)

Pécs University Faculty of Medicine

Department of Otorhinolaryngology

Registration Form

Name: ________________________________________________________

Institute: _______________________________________________

Address: _______________________________________________

City: __________________________________________________

Country: _______________________________________________

ZIP code: _______________________________________________

Phone: _________________________________________________

Fax: ___________________________________________________

E-mail: _________________________________________________

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

( ) DEM 600.00 - with dissection

( ) DEM 400.00 - 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/course6.htm

Program

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