25TH SYMPOSIUM OF THE INTERNATIONAL 
SOCIETY OF DERMATOPATHOLOGY
DISCOVERIES IN DERMATOPATHOLOGY
SEPTEMBER 16 – 18, 2004

Centro Cultural de Belém
LISBON, PORTUGAL

 
REGISTRATION FORM
PERSONAL DATA
LAST NAME 
FIRST NAME

TITLE:
 Prof  Dr  Mr  Ms

ADDRESS 

CITY / STATE
ZIP CODE
COUNTRY
 
PHONE
EMAIL
 
FAX

ORGANISATION 

ACCOMPANYING PERSON

Ms Mr
LAST NAME 
 
FIRST NAME 

 

 

1. REGISTRATION

Registration Fees

Payment by 
May 31 2004
Payment after 
May 31 2004
ISD member  320 € 400 €
Non-member 380 € 480 €
Residents (*) 100 € 120 €
Self-Assessment course in Dermatopathology (**) 120 € 120 €
Gala Dinner 60 € 60 €
Accompanying person 50 € 50 €

(*) a confirmation letter signed by the chairman of the Department is necessary
(**) on-site registration to the Self-Assessment course is possible only if free places are still available

TOTAL 1 =

 

2. HOTEL RESERVATION

Arrival Date Departure Date  Number of nights
SINGLE ROOM DOUBLE ROOM
Pestana Palace ***** Deluxe 260 Euro 280 Euro
Altis Hotel ***** 160 Euro 180 Euro
Sofitel****  142 Euro 162 Euro
Vila Galé Opera**** 110 Euro 120 Euro
Hotel da Torre *** 57 Euro 67  Euro
Ibis Liberdade ** 80 Euro 95 Euro

Prices are per room per night and include taxes and service charges. 

TOTAL 2 =

 

3. TOURS 

Price p/ person 
Details in Social Programme
1. Lisbon City Tour – Half day tour  30  Euro
2. Lisbon City Tour – Full day tour  73  Euro
3. Outskirts of Lisbon: Sintra/Cascais – Full day tour 67  Euro
Nº persons

TOTAL 3 =

GRAND TOTAL 1+2+3 =

Payment conditions:

- Full amount must be paid upon submission of the appropriate booking form

- Terms of payment: payment must be sent to the Organising Secretariat (Mundiconvenius) when applying for registration, by means of:

- Bank check issued in name of
Sociedade Portuguesa de Dermatologia
e Venereologia

- Bank transfer to:
Sociedade Portuguesa de Dermatologia e Venereologia

Bank: Caixa Geral de Depósitos
IBAN: PT50003505780001414793007
SwiftCode: CGDIPTPL

>>>>

 

 

Congress Secretariat:
MUNDICONVENIUS
Rua do Embaixador, 13 - 2 - 1300-215 Lisboa – PORTUGAL
Tel: ++ 351 213 649 498 Fax: ++ 351 213 649 523
Email:
saudade_leitao@mundiconvenius.pt