Title: Folie 1
1please stamp
General Information
Recent Advances in Medical Gas Therapy
Contact
28th October 2006Amsterdam, the Netherlands
Department of Anesthesiology VU University
medical centrum De Boelelaan 1117 1081 HV
Amsterdam The Netherlands
Congress Venue
OZW Opleidingsinstituut Zorg en WelzijnDe
Boelelaan 11091081 HV AmsterdamThe
Netherlands ? www.ozw.nl
organized by
2Scientific Program
Registration
I hereby register to attend the symposium Recent
advances in medical gas therapy on 28th October
2006 in Amsterdam, the Netherlands.
Name __________________________________________
Firstname _______________________________________
Middle Initial ___________________________________
_
Title ____________________________________________
Department ____________________________________In
stitution ____________________________________
Street / Number _________________________________
City / Area Code ________________________________
Country _________________________________________
Telephone ______________________________________
Fax _____________________________________________
Email ___________________________________________
Accreditation has been applied for with
- 75,00 full entrance fee
- 20,00 reduced entrance fee for VUmc
employees and ISMG members
NVA Nederlandse Vereniging voor Anesthesiologie
Entrance fee includes admission to lectures,
abstract booklet and refreshments.
NVIC Nederlandse Vereniging voor Intensive Care
NVALT Nederlandse Vereniging van Artse voor
Longziekten en Tuberculose
___________date
________________________________Signature
UEMS European Union of Medical Specialists