May 24-26, 2001
("regform7.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 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