INDIVIDUAL REGISTRATION FORM (please fill in CAPITAL letters)

Transcription

1 PLEASE RETURN THIS FORM BY , FAX OR BY MAIL TO: MCI Suisse SA, Official Registration and Housing Bureau On behalf of IOF Regionals - 1 st Middle-East & Africa Osteoporosis Meeting Rue de Lyon 75 CH-1211 Geneva - Switzerland Tel.: +41(0) Fax: +41 (0) iofdubai2011.reg@mci-group.com INDIVIDUAL REGISTRATION FORM (please fill in CAPITAL letters) Prof/Dr/Mrs/Mr/Ms: Institution / Company: Mailing Address: Postal Code: City: Country: Telephone Country Code: Area Code: Number: Fax Country Code: Area Code: Number: Accompanying Person(s) name(s): Profiling of Registrant Endocrinologist Rheumatologist Geriatrician Orthopaedic Surgeon Radiologist Internist Rehabilitation Physician General Practitioner Pharmacist Physiotherapist Nurse Other Allied Health Professional Post-doctoral Researcher / Fellow Scientist Industry Business Media Other Profiling of Organisation/Employer Public/General Hospital or Affiliate Private Hospital/Practice University Community Health Research Laboratory Health Department / other Governmental Organisation Non-Governmental Organisation Industry Other Special Needs It is important to us that you enjoy the IOF Regionals - 1 st Middle-East & Africa Osteoporosis Meeting. If, due to a disability, you have any special needs, please let us know and we will do our best to assist you. Please specify: Yes No 1

2 Registration Fee Please tick the appropriate box Categories 1 Early Bird Until September 5, 2011 Pre-Registration 2 Sept 6 Oct 18, 2011 On-Site October 19 22, 2011 Regular Participant Allied Health Professional Student/Fellow World Bank non- high income 4 nations Accompanying Person For full definition of Registration Categories, please refer to the information available online at 2 No pre-registration will be accepted after October 18, Registration On-Site will be available during the Meeting. 3 A certification and signature from either a mentor/supervisor verifying training/degree status or from an employer verifying paramedical/non-doctoral status must be included when registering 4 Eligible World Bank non-high income nations: Egypt, Iraq, Iran, Jordan, Lebanon, Pakistan, Palestine, Syria and African countries 5 This badge includes admission to the Welcome Reception and Exhibition Area, but does not allow access to the Scientific Programme, Satellite Symposia, Poster Sessions, lunches and coffee breaks. All registration fees are exempted of taxes and are quoted in United States Dollars () for all categories. TOTAL DUE (A) Participant s registration fee includes: Admission to all Plenary Sessions, Meet-the-Expert Sessions, Satellite Symposia, Poster Sessions and Exhibition Area One copy of the Programme & Abstract Book A Meeting bag containing official material and a Meeting badge A certificate of attendance Coffee breaks & lunches Opening Ceremony & Welcome Cocktail The registration fee does not include: Airport transfers Local transportation to the Meeting venue Other meals & drinks Accommodation Excursions Insurance Please confirm your participation for: Opening Ceremony & Welcome Reception, Wednesday October 19, 2011 First evening, a reception is organized for participants, registered accompanying persons and exhibitors Meet-the-Expert One per Session: Please tick the appropriate box(es) Thursday, October 20, :30 09:20 Osteoporosis Management in the Frail Elderly (Gemma Adib/ Syria) Role of Nutrition in Bone & Muscle Health (Bess Dawson-Hughes/USA) Management of Premenopausal Osteoporosis (Serge Ferrari/Switzerland) Customising FRAX in Middle-East & Africa Region (John A. Kanis/United Kingdom) Assessment of Bone Quality (Ego Seeman/Australia) Friday, October 21, :30 09:20 Osteoporosis Management in the Frail Elderly (Gemma Adib/ Syria) Role of Nutrition in Bone & Muscle Health (Bess Dawson-Hughes/USA) Management of Premenopausal Osteoporosis (Serge Ferrari/Switzerland) Customising FRAX in Middle-East & Africa Region (John A. Kanis/United Kingdom) Assessment of Bone Quality (Ego Seeman/Australia) 2

3 Excursions All excursions are conducted in English language. Excursions duration, date of the operation are subject to change. The tour can be cancelled if minimum number of participants is not achieved. All excursions pick-up and drop-off point is from the InterContinental Festival City Event Centre Lobby. Kindly report to pick-up point 15 minutes prior to tour timings. N of Total Tour Date Time Cost Tickets City of Merchants - Dubai Orientation Tour Thursday 19 October 09:00-13: Saturday 22 October 14:00-18: Modern Do Buy Shopping Tour Thursday 19 October 09:00-13: Saturday 22 October 14:00-18: Dhow Cruise Saturday 22 October 18:30 21: Desert Safari Saturday 22 October 15:30-20: High Tea at Burj Al Arab - The Arabian Tower Thursday 19 October 09:00-13: Saturday 22 October 14:00-18: Burj Khalifa Observatory Deck / Dubai Mall* Thursday 19 October 09:00-13: Saturday 22 October 14:30-21: *For your safety, the outdoor terrace may need to close during severe weather conditions. Refunds and rain checks are not offered for inclement weather or closure of the elevators. Strictly subject to availability only as bookings will be confirmed 30 days before the tour dates TOTAL DUE (B) Hotel Accommodation For your reservation, please fill in this form and return it not later than September 5, As hotel accommodation is subject to availability, requests received after this date will not be guaranteed. Reservations are made on a first-come, first-served basis. Availability of rooms in each category is limited. Name of persons sharing rooms must be indicated. All rates are quoted in United States Dollars (), per room, per night, and include breakfast, 10% municipality charge and 10% service charge (as per April 2011). Rates apply for standard room; other room types like deluxe room, junior suite, suite, etc. are available upon request. Only guaranteed reservations will be accepted. A first night deposit is required to secure your hotel booking. This prepaid deposit will be deducted from your hotel bill when checking out from the hotel. Additional expenses such as mini-bar and telephone must be paid directly to the hotel when checking out. From September 5, only payment made by credit card will be accepted. Group reservations will be handled by MCI Suisse SA with separate contracts. Please indicate your choice of hotels in order of preference (one form per registrant) Reference Hotel Rank Location Single Double Occupancy Occupancy 1 InterContinental Festival City 5-Star Connected to Conference Venue Crowne Plaza Festival City 5-Star Connected to Conference Venue Al Bustan Rotana 5-Star 15 Driving Distance Flora Grand Hotel 4-star 20 Driving Distance Arabian Park Hotel 3-Star 25 Driving distance st choice: 2 nd choice: 3 rd choice: Arrival date: Single room Double room Twin room (2 beds) Departure date: Sharing with: First Name Family Name Number of nights: 1 st night deposit TOTAL DUE (C) TOTAL DUE (A)+(B)+ (C) 3

4 Conditions of Payment (Please tick the appropriate box) Payments: All registration fees must be paid in advance in United States Dollars () payable to MCI Suisse SA, on behalf of IOF Regionals - 1 st Middle-East & Africa Osteoporosis Meeting - 75 rue de Lyon, CH-1211 Geneva 13, Switzerland. No confirmation will be sent until MCI Suisse SA has received the payment. By bank transfer, in United States Dollars () made payable to: MCI Suisse SA Rue de Lyon 75 - CH-1211 Geneva 13, Switzerland Bank Name/Address: UBS SA - 35 rue des Noirettes - CH-1227 Carouge, Switzerland Account Number UBS : X Swift/BIC: UBSWCHZH80A IBAN: CH X Please indicate your first and family name, your registration number (mentioned on the registration invoice), and "1 st IOF Middle-East & Africa Osteoporosis Meeting". All costs are to be borne by the ordering customer and please mention "free of charge for the receiver account" on all payments. By credit card. I authorise MCI Suisse SA to charge my credit card for the total amount indicated above: Eurocard /MasterCard Visa American Express Cardholder's name: Expiry date: Card number: Security code (CVC)*: Signature and date: *CVC: Your card security code is a three or four digit number. For Visa and Eurocard, the code is the last three digits printed on the signature strip on the back of the card. For American express, the code is the four digits printed on the front of the card. Confirmation of Registration and Hotel Booking Upon receipt of your duly completed registration form, we will issue and send you the invoice or confirmation and receipt corresponding to the registration and service(s) (subject to availability) requested. No registration and/or service(s) booking will be confirmed until the full invoice is paid. Please present your confirmation letter at the Registration Desk in order to obtain meeting documentation and badge. Remember to state participant name and MCI Suisse SA - 1 st IOF Middle-East & Africa Osteoporosis Meeting as well as your invoice or registration number on all payments. Payments, Cancellation and Refunds Cancellations and changes to your original registrations (including Social Events) and hotel bookings must be made in writing to MCI Suisse SA by at iofdubai2011.reg@mci-group.com or by fax at +41 (0) Please see conditions below: Payment conditions Registration, Social Events and Excursions Full payment of these items is requested when registering (by credit card or by bank transfer). No confirmation will be sent until MCI Suisse SA has received the payment. All cancellations must be sent to MCI Suisse SA in writing (fax, letter, or ). Hotels Important: A first night deposit is required to secure your hotel booking. This prepaid deposit will be deducted from your hotel bill when checking out from the hotel. Additional expenses such as mini-bar and telephone must be paid directly to the hotel when checking out. From September 5, only payment by credit card will be accepted. Cancellation, Modifications and Refund Policy Registration, Social Events and Excursions Notification of cancellation and refund requests must be submitted in writing, preferably by , by September 5, 2011 to the Official Registration and Housing Bureau (MCI Suisse SA) at the contact details listed below. An administrative fee of 20% will be deducted from the total amount originally due/charged. All refunds will be made after the Meeting. No refunds will be given for cancellations received after September 5, Individual Badge Name Changes (Substitution of Registration) An administrative fee of 55 per badge will be charged for a badge name change after September 5, Written permission from the original participant will be required, along with full contact details of the substitution. Hotels All changes to hotel reservations will be handled by MCI Suisse SA. Please do not contact the hotel directly. A handling fee of 55 per hotel room will be charged for every hotel modification received after September 5, All cancellations must be sent to MCI in writing (fax, letter, or ). For cancellations received before September 5, 2011, deposits will be refunded less 100 for administrative costs. After this date, no refund will be possible. In case of late cancellations (after September 5, 2011), cancelled rooms, cancelled nights or no-show, we reserve the right to charge the full stay if the hotel room can not be re-sold. 4

5 Liability and Insurance The Meeting Organizer (IOF), the Meeting Venue (InterContinental Festival City Hotel), its official appointed Registration & Housing Bureau (MCI Suisse SA) and Exhibition & Sponsorship Agency (MCI Middle East LLC) and any suppliers, representatives or agents linked to the organization of the Meeting shall not be held liable by any person for any injury, damage, theft, loss, medical problem or inconvenience which may be suffered by any person while traveling to or from, or during such person s presence in Dubai in connection with this Meeting. Participants and their guests are advised to purchase their own insurance against any such occurrences. Cancellation or Modification of the Meeting due to Force Majeure In case of force majeure, the Meeting organizers have the right to alter or cancel the Meeting without prior notice, however a notice of the occurrence shall be given by IOF as soon as reasonably possible. Force majeure shall mean any circumstance beyond the reasonable control of IOF which prevents or impedes the holding of the Meeting, including, but not limited to, government action, war or hostilities, riot or civil commotion, plague or other epidemic such as SARS, bird flu, etc, earthquake, flood, hurricane, tsunami, cyclone, fire or other natural physical disaster, explosion, accident or breakdown, strike, lack of the usual means of transportation or terrorism or due to events which are not attributable to wrongful intent or gross negligence of the IOF. IOF shall not be liable for any direct or indirect, incidental or consequential damages, losses, expenditures or any other inconveniences or costs caused by such modification or cancellation of the Meeting. Furthermore, registration fees will not be reimbursed by IOF. Force Majeure for Hotel Accommodation MCI Suisse SA and the Hotel(s) are not responsible for either the partial or total non-execution of the contract in the event of accident, an act caused by a third party, or in case of major force such as: special measures taken by the government or local authorities, total or partial strike, lockout, fire, threats to public safety including terrorism, war, health hazards, natural disasters, flood, or some other comparable events or disaster which prevents the Hotel(s) from accommodating the clients of MCI Suisse SA for the event or if for the same reasons the event is cancelled by MCI Suisse SA. Disclaimer All reasonable endeavors will be made to hold the Meeting and to present its programme as scheduled under circumstances which assure the comfort and safety of all participants and their guests. However, the IOF reserves the right to modify the programme, unilaterally and without notice. Neither IOF, nor their officers, directors, employees, representatives or agents, shall be held liable by any person as a result of the cancellation of the Meeting or any of the arrangements, programs or plans connected therewith, or for any injury, damage or inconvenience which may be suffered by any person while travelling to or from, or during such person s presence in Dubai, UAE in connection with this Meeting. Participants and their guests are advised to purchase their own insurance against any such occurrences. Any litigation stemming from the above contract will be tried in Nyon, Switzerland where the Swiss law is exclusively applicable. Remember to make a copy of this form for your own files. Signature: Date: 5