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6th Congress of the European Society for Analytical Cellular Pathology Heidelberg, Apr.7-11, 1999 |
Institution _______________________________________________________________________________________
Street: ________________________________
ZIP Code: _______________
City:____________________________
Country: _______________________
Phone:(+country/area code) ___________________
Fax:__________________
E-mail _________________________________________________
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payment received before Feb.15 |
payment received after Feb.15 |
your balance |
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550DM 720DM 500DM 180DM 50DM |
630DM 800DM 580DM 180DM 50DM |
______ ______ ______ (on site paym.) _____ _____ |
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1.Bank Transfer ("Überweisung"/Euro-Transfer) Deutsche Bank, München-Großhadern, acc.nr: 571 548 702, bank nr. 700 700 10, please label to: "6thESACP Congress + your name" for correct booking
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2.Credit Card Payment ___ Master/Eurocard, ___ VISA, ___ AMEX, Card nr: _________________________
valid until: _____________, name of card holder _____________________________ city __________________, date: ______________, signature: __________________
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3.Cheques (please label to: "6thESACP Congress + your name" for correct booking) - Eurocheques are accepted, please send cheque together with this On-line Payment Form to Heidelberg - Overseas cheques: please use credit card to lower banking costs
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