Oonsite Registration form   (By cashr)	
 　　   5th World Congress of Clinical Safety
By International Association of Risk Management in Medicine  
                    (IARMM)
   	  21st(Wed) – 33rd (Fri) September, 2016
              Harvard University, Boston, USA
                
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▲ First name                                        ▲ Middle name    
      
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▲ Last name                                        ▲ Telephone number
                                                 
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▲ Title                                          　 ▲ Fax number
                                                 
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▲ Institution                                      　▲ Email address

▲	Postal address　   

A. Registration fee                                                     	
This registration is not valid before our confirmation of your payment.
Please mark ㇾ at your choice.  

The registration is closed from 10 Sep 2016 to 20 Sep 2016..

Onsite registration  (21, 22, 23 Sep 2016)	Price	Price	
	IARMM non-member	IRMPM member, Resident and Graduate student	
Delegate Fee for 3 days (The price is tax free.)	$1,650	$1,350	
Delegate Fee for 2 days (The price is tax free.)	$1,100	$900	
Delegate Fee for 1 day (The price is tax free.)	$550	$450	
Dinner Ticket*  (not included in any package. 
The price includes VAT.)	 $100*	 $100*	

* If your trust or organisation is not paying for your dinner ticket you should register as a delegate to receive your invoice for the delegate registration only and you can then register separately for your gala dinner tickets to receive a separate invoice.
 (Term condition)  On a case of cancellation, registration fee is not refunded.
When a delegate replaces with another person, email the request to the following office.

The delegate fees cover all printed materials (proceedings, journals, etc), catering for coffee breaks, lunch, and the other registration services.  It doesn’t include dinner.

A student and a resident should fax a copy of the ID card with photo.

B. Hotel accommodation	
  Followings are our recommendation for your search.
  http://www.iarmm.org/5WCCS/RECOMMENDED%20HOTELS%20listing%20for%20attendees.pdf

Please note that IARMM in no way indorse these hotels or take responsibility for your booking with your chosen hotel. Your booking is a contract between yourself and your chosen hotel.

5th World Congress of Clinical Safety 2015 in Boston
Administration Office
　International Association of Risk Management in Medicine (IARMM)
(Tel / Fax) 　+81-3--3817-6770 
(Email)  manager@iarmm.org
4-7-12-102 Hongo, Bunkyoku, Tokyo,113-0033, JPN