XXIIIrd INTERNATIONAL WINTER MEETING
St. Moritz/Switzerland, March 18 – 21, 2010

Registration Form 
(Please type or print in block letters)

Family name	......................................................	Title	.........  First name..........................
Institution	......................................................	Phone	......................................................
Address	...................................................... 	Fax	......................................................
	...................................................... 	Email	......................................................
Postal Code	.............	City  .............................	Country	......................................................

Registration Fee: 	Early bird rebate	Late registration
		Until Jan. 24, 2010	After Jan. 24, 2010

Regular		 CHF 250.-	 CHF 350.-
Student/PhD student	 CHF 100.-	 CHF 150.-

Social Dinner	 CHF 90.-/person  	Number of persons 	........
(Saturday night, March 20, 2010)	
		Total Fee	CHF ........

Cancellation terms: Until Jan. 31, 2010: 50% - after Jan. 31, 2010: no refund.

Accommodation

1.  Recommended residential on-site accommodation at the hotel hosting the venue. A contingent of rooms has been reserved at special rates, and will be available only to registered participants. After registration, we will send you a booking code, which will enable you to book these rooms. Accomodation will be at: Hotel Laudinella, Via Tegiatscha 17, CH-7500 St.Moritz-Bad, Tel. +41-81-836 0608, Website: www.laudinella.ch E-Mail: info@laudinella.ch 

2.  For off-site accommodation alternatives, please contact the Tourist Office of St. Moritz, CH-7500 St. Moritz, Tel. +41-81-837 3333, Fax +41-81-837 3377, Website: www.stmoritz.ch E-mail: stmoritz@estm.ch 

Please select one of the two following methods of payment:
  1. Wire transfer to our bank account:

Account No.: 233-564381.01N 
Bank: Union Bank of Switzerland (UBS)
CH-4153 Reinach 
IBAN: CH67 0023 3233 5643 8101 N 
BIC: UBSWCHZH80A

Account Holder: 
Swiss Society of Neuropathology

Please indicate your name 
and  “St. Moritz Meeting 2010”
___________________________________

Please return form to:
Mrs Astrid Dollinger 
Institute of Pathology
University Hospital Basel
Schönbeinstrasse 40, CH-4031 Basel
Phone: +41 61 265 2873, Fax: +41 61 265 3194
E-Mail: adollinger@uhbs.ch
  2. Credit Card

Mastercard/Eurocard	Visa            
American Express	 

Credit Card No.:    ........   ........   ........   ........   

CVV2 Code*:         ........

* three digit number printed on the signature panel on the back of VISA and Mastercards.
	
Exp. Date (mm-yyyy)  ........  -  ................ 

Name and full address of card holder: 

......................................................
......................................................
......................................................

Signature: 

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