 |
Gender*
|
 |
|
|
Title*
|
|
|
|
First name*
|
|
|
|
Family name*
|
|
|
|
Position*
|
|
|
|
Department
|
|
|
|
Faculty/School
|
|
|
|
Institute | University | Organisation*
|
|
|
|
Mailing address*
|
|
|
|
City*
|
|
|
|
Zip code
|
|
|
|
State
|
|
|
|
Country*
|
|
|
|
Telephone*
|
|
|
|
Email*
|
|
|
|
Internet
|
|
|
|
Abstract Thematic poster session
|
|
Abstract (will be) submitted |
|
Proposal for Mini-workshop
|
|
Proposal (will be) submitted |
|
Proposal for Didactic session
|
|
Proposal (will be) submitted |
|
Special food requirements
|
|
|
|
I am also registering for: |
|
Pre-conference workshop on Saturday November 13 |
|
|
I am also registering for:
|
|
The post-conference excursion to B.P. Koirala Institute of Health Sciences in Dharan, from November 18 - 20 (information available at: http://www.the-networktufh.org/conference/programme.asp)
|
|
Accompanying person
|
|
I will bring an Accompanying person to the main conference in Kathmandu, Nepal
I will bring an Accompanying person to the post-conference excursion to B.P. Koirala Institute of Health Sciences in Dharan, from November 18 - 20.
Accompanying persons may not attend the conference sessions and workshops!
|
|
Sponsoring a conference attendee
We invite you to make a donation toward sponsoring conference attandees from developing countries
(Check only ONE box)
|
$5
$10
$15
$25
$50
$100
|
|
Payment details
|
| Members of The Network: TUFH
Conference registration fee: US $ 550 before June 1
Conference registration fee: US $ 600 after June 1
Pre-conference workshop fee: US$ 100
Post-conference excursion fee: US$ 120
Non-members of The Network: TUFH
Conference registration fee: US $ 600 before June 1
Conference registration fee: US $ 650 after June 1
Pre-conference workshop fee: US$ 100
Post-conference excursion fee: US$ 120
Staff participants from Nepal
Conference registration fee: US $ 300
Partial registration fee: US$ 180
Pre-conference workshop fee: US$ 50
Post-conference excursion fee: US$ 120
Student participants from Nepal
Conference registration fee: US$ 250
Partial registration fee: US$ 140
Pre-conference workshop fee: US$ 50
Post-conference excursion fee: US$ 50
Students
Conference registration fee (undergraduate): US$ 250
Conference registration fee (postgraduate): US$ 400
Pre-conference workshop fee: US$ 50
Post-conference excursion fee: US$ 50
Accompanying persons
Main conference programme fee: US$ 225
Post-conference excursion fee: US$ 120
Hotel deposit
US$ 150 or a credit card to guarantee the booking |
|
|
|
Credit Card details will follow by fax. (click here to download the form)
Currency exchange differences may incur additional charges. An additional 5% processing fee will be added.
Bank transfer
Account no. 46.47.45.497, ABN-AMRO Bank,
Avenue Ceramique 27, 6221 KV Maastricht, The Netherlands.
BIC code: ABNANL2A / IBAN: NL22 ABNA 0464 7454 97
Please indicate
1) your name;
2) 2010 Network: TUFH conference - Nepal;
3) without costs for the receiver
Bank charges are applicable.
Cheque
Preferably drawn on a Dutch Bank to the attention of the 2010 Network: TUFH Conference - Nepal.
Pls. use only 1 cheque for registration + hotel deposit.
Bank charges of US$ 17 are applicable.
|
|
Accommodation |
|
Participants/Accompanying persons can stay in one of the below mentioned accommodations. Accommodation requests will be handled on a first come-first serve basis. Reservations can only be made after receipt of your hotel deposit and arrival/departure date.
|
|
Arrival date
|
|
November 2010
|
Departure date
|
|
November 2010
|
|
Type of room
|
|
|
Name roommate
|
|
|
| My roommate is |
|
|
|
|
|
Accommodation in Kathmandu (main conference)
In case not otherwise indicated, the rates are per room, per night, including breakfast and taxes. |
|
|
Soaltee Crown Plaza (Conference Venue)
Single room: US$ 115
Double room: US$ 120
Rates do not include 10% service charge and 13%VAT.
http://www.crowneplaza.com/
Grand Hotel
Single room: US$ 40
Double room: US$ 45
Rates do not include 10% service charge and 13%VAT.
http://www.grandhotelnepal.com
Kathmandu Guest House
Single room: US$ 30 - US$ 35
Double room: US$ 40 - US$ 45
Rates do not include 10% service charge and 13%VAT.
http://www.ktmgh.com/
Hotel Holy Himalaya
Single room: US$ 20,40 - US$ 29,40
Double room: US$ 26,40 - US$ 41,40
Rates do not include 10% service charge and 13%VAT.
http://www.holyhimalaya.com/
Own accommodation
|
