Sex
Male
Female
Title
First name *
Middle name/Initial
Family name *
Primary Speciality *
...
Paediatrics
Pharmacology
Paediatric Pharmacology
Pharmacogenetics
General practitioner
Pharmacy
Nurse
Others
Paediatric Subspeciality:
PhD candidate in pediatric pharmacology
PhD candidate, other
PhD For those with PhD, please provide the field of research.
Institution/Company/Other Affiliation *
Department
Current position:
City *
Postal/Zip code *
Country *
E-mail *
Category_Registration *
Early Registration
Late registration
Registration after May 14, 2011
Category_Delegates *
1A
1B
1C
1D
2A
2B
3A
3B
4A
4B
Category_Education day only:
1A
1B
2A
2B
3A
3B
Payment: Your congress registration will be confirmed upon payment of the congress fee through the bank DNB NOR, no on-line pay ment.
Payment: I Norwegian participants use the following bancaccount nr:
1503 1852 983 ; DNB
Payment 2 International participants, please use the following IBAN nr for payment in Euro:
NO03 1250 6069 821
BIC address: DNBANOKKXXX
Banc: DNB NOR
As the bank system in USA and Canada differs you may need to fill in the name and address of the bank:
DNB NOR Bank ASA
0021 OSLO, Norway
For European participants there is no need for this as this goes automatically by the IBAN and BIC address.
Book Your Accomodation at Holmenkollen Park Hotel As the number of rooms are getting short already by the time of mid April 2011, there is no guarantee of available rooms. Please, contact betty.kalikstad@medisin.uio.no . Your request will be forwarded to Holmenkollen Park hotel.
Contact Data Provide information on your name, address and e-mail in the following textbox.
Date of Arrival and Departure When booking your Accomodation at Holmenkollen Park Hotel it is mandatory to provide the date of your Arrival and Departure.
Total number of nights Please, provide the total number of nights at Holmenkollen Park Hotel AND if you prefer a single or a double room in the textbox.
You may find further information about the accomodation in the link to the Venue.
Creditcard Please, fill in your creditcard number in the textbox below AND expire day.
NOTE:
The purchase for your accomodation will be guaranteed through your creditcard.
Please, provide your creditcard number AND expire date only, NOT the security code.
Your payment will be purchased at the time of departure.
Please Note:
Cancellation & Refund Terms for booking your Accomodation through this website:
Upon 48h in advance of June 14th 2011 you may cancel your booking through this website. click here
Within 48h you will be charged for 1 booking night.
Please, fill in your creditcard number in this textbox.
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