Registration Form for the 7th European Congress on Violence in Clinical Psychiatry
Please, send (or fax to ++ 31 (0)20 409 0550) your completed registration form and indication of payment to: Oud Consultancy & Conference Management, Hakfort 621, 1102 LA Amsterdam, the Netherlands.
Congress fees / Dinner / Workshops Please tick the appropriate boxes and fill in with how many persons you will attend the Congress Dinner.
Registration & payments for pre-congress workshops is only possible in combination with registration & payments for the main congress on violence in clinical psychiatry as well.
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Registration & Payment After 31-7-11
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Registration & Payment After 31-7-11
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Bank transfer
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Creditcard 5%
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Regular
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€ 645,-
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€ 677,-
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EVIPRG/WPA/CPA* member
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€ 595,-
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€ 624,-
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Congress Dinner
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Number of persons: x
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€ 75,-
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€ 79,-
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Total Dinner:
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= € ,-
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= € ,-
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Pre-Congress Workshops
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(1) START (10.00-13.30)
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€ 100,-
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€ 105,-
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(2) EAMHID (14.30-18.00)
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€ 100,-
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€ 105,-
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(3) CAPP (14.30-18.00)
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€ 100,-
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€ 105,-
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Total Workshops:
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€ ,-
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€ ,-
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Total:
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€ ,-
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€ ,-
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* EViPRG: European Violence in Psychiatry Research Group WPA: World Psychiatric Association CPA: Czech Psychiatric Association
I declare that I am:
- a regular participant
a EVIPRG member a WPA member (please send us by e-mail attachment a copy of your membership card) a CPA member (please send us by e-mail attachment a copy of your membership card)
I declare that I have read the general information and registration and payment conditions and I agree with the release and waiver of liability policies, the disclaimer, as well as the policies regarding cancellations and registration refunds.
In consideration of my participation in the 7th European Congress on Violence in Clinical Psychiatry, I do hereby release, discharge and hold harmless Oud Consultancy and cosponsors, from any and all liability by reason of any damage, loss, expense, or injury arising from my participation in this event, including that caused solely or in part by the fault (including but not limited to negligence, gross negligence, and recklessness) of the above-named parties. This release and Waiver of Liability shall be binding on my heirs, executors, administrators, successors, and assigns.
Payment
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