National Service of Forensic Psychiatry in Lithuania - Registration form

National Service of Forensic Psychiatry in Lithuania

under the Ministry of Health

News

Registration form

Registration form

VII INTERNATIONAL CONFERENCE OF FORENSIC PSYCHIATRY
“DESIRES AND IMPULSES – NORM AND PATHOLOGY”
5 – 7 October 2011, Palanga, Lithuania

REGISTRATION FORM

Title*:
First name*:
Name*:
Office, institution*:
Address*:
Country*:
Code*:
Tel.*:
Fax*:
E-mail*:
Accompanying persons*:

Registration fees	by 01/09/11	after 01/09/11	payment
Registration	120 EUR	150 EUR
Accompanying person	50 EUR	70 EUR
Single room (breakfast & lunch included per day)	85 EUR (a day)	100 EUR (a day)
Double room (breakfast & lunch included per day)	60 EUR (a day)	80 EUR (a day)
Gala dinner	50 EUR	50 EUR

		Total

Your reservation at the hotel “GABIJA” **** from -10-2011 to -10-2011 for days

If NO, your preference:
Registration and accommodation must be paid to:

Lithuanian Forensic Psychiatry Association A.Kojelavičiaus str. 121, LT-11106 Vilnius, Lithuania Tel.: (370-5) 267 72 00, fax.: (370-5) 267 72 10 E-mail: info@vtpt.lt	Lithuanian Forensic Psychiatry Association Account № LT437300010002467156, Code 73000 AB Bank “Swedbank”, Vilnius regional division, Lithuania
Please return this form duly filled by post or fax until 1 September 2011.
Security code*:

Contacts

A.Kojelavičius str. 121,

LT-11106 Vilnius

Tel. 8~5 2677200

E-mail.: info@vtpt.lt

State budget office.

Code 191671615

We care about your opinion

Lithuanian Forensic Psychiatry Association

Solution: Fresh media. Powered by EasyWeb 3.0