Registration for the 22nd IPPNW ESC in Berlin 2012

Full name*:

Address line 1*:

Address line 2*:

Address line 3:

Country*:

Gender*:

eMail-Address*:

Telephone number (with international code)*:

Diet*

Diet*all
vegetarian

Arrival by car

Arrival by carYes
No

Estimated date and time of arrival?

Anything else we should know? (e.g. need an invitation letter, special diet, handicapped persons)

In case you want to offer an own workshop please describe it here.

I would like to register for the 22nd IPPNW European Students Conference from 12th-15th of April in Berlin. I confirm to transfer the registration fee within the next 7 days. As we we can only offer a limited amount of places, we might have to restrict the number of registrations. We will consider registrations on a "come first, take first" basis, but save 50 places for international registrations. In the case of less than 50 international registrations until 12th March 2012, we will offer the remaining places to all students and then prefer IPPNW members to non-members. We appreciate your understanding! *

Registration fees incl. accomodation and meals:

100 €

I require accomodation in Berlin. (Please note, that we don't offer a reduced fee for private accomodation!)*

I require accomodation in Berlin. (Please note, that we don't offer a reduced fee for private accomodation!)*Yes!
No

(*= required field)

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