Registration form   (company presentation	
 　　   6th World Congress of Clinical Safety
By International Association of Risk Management in Medicine  
                    (IARMM)
   	  6(Wed) – 8 (Fri) September, 2017
                                     Ambasciatori Palace Hotel, Rome, Italy

This for is for a company who gives the oral presentation (30 min).  This form doesn’t include product exhibition.  If want to give exhibition please email to us.

Registration deadline: 30 June 2017. 
  
 After you fill this registration form, fax it to the following registration office (+81-3-3817-6770).
 Also, submit your abstract (300 words) by email.

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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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▲ Company name                                   　▲ Email address

▲	Postal address　   

▲	Website　   

A. Registration fee                                                     	
This registration is not valid before our confirmation of your payment.

€20, 00 per 1 oral presentation and 1 poster presentation for 3 days

  (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 (e-proceedings, e-journals, etc), catering for coffee breaks, lunch, and the other registration services during 3 days.   It doesn’t include dinner.

B. registration payment way	
　　  　　　　　　

In a case of bank transfer, send the following bank account.
Bank name: Bank of Tokyo-Mitsubishi UFJ
Branch name: Hongo Branch
Branch number: 351
Account name: IARMM
Account number: 0111719
Sift code: BOTKJPJT

(Note)  For check use, you have to get an international check (Demand Draft) in your bank.  Thus, instead of check payment, you should use the following bank transfer. We don’t accept any check. 

You can use PayPal, too, if wish.

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In a case of bank transfer payment, please fax this form to the following office till the registration deadline.
And, fax a copy of your receipt, too.

6th World Congress of Clinical Safety 2017 in Rome
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