Registration Form

9^th International Course in Modern Rhinoplasty Techniques

May 22-24, 2003

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University of Pécs 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):

( ) EUR 500 - with dissection

( ) EUR 300 - without dissection

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

Attn. Antalovicsné Boros Rita

Address: University of Pécs, Faculty of Medicine

Department of Otorhinolaryngology

Munkácsy M. u. 2.

Pécs, Hungary

H-7621

Phone/Fax: +36 72 312-151