Offline Registration form   (Onsite)	
 　　   8th World Congress of Clinical Safety
By International Association of Risk Management in Medicine  
                    (IARMM)
   	  2nd (Wed) – 4th (Fri) October 2016

         
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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                                                     	

The registration is closed from 16 Sep 2019 to 1 October 2019.

Onsite registration  (2, 3, 4 October 2019)	Price	Price	
	IARMM 
non-member	IRMPM member, or Undergraduate student	
Delegate Fee for 3 days (The price is tax free.)	(   ) € 660	(   ) € 600	
Delegate Fee for 2 days (The price is tax free.)	(   ) € 440	(   ) € 400	
Delegate Fee for 1 day (The price is tax free.)	(   ) € 220	(   ) € 200	

* 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.

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.

An undergraduate student should email us a copy of the ID card with photo.

B. Hotel accommodation	
If you book your room in the above congress hotel, the hotel offers 15% discount price for a congress attendee. In this case, contact the above hotel directly as an our Congress delegate by yourself. 
Email to reservation@hotel-grandior.cz.
Call for +420 211 159 854

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.
C. registration payment ways	
　　  　　　　　　
Cash ONLY.

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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.

8th World Congress of Clinical Safety 2019 in Prague
Administration Office
　International Association of Risk Management in Medicine (IARMM)
(Tel / Fax) 　+81-3--3817-6770 
(Email)  8wccs@iarmm.org 
4-7-12-102 Hongo, Bunkyoku, Tokyo,113-0033, JPN