REGISTRATION FORM
10TH SEMINAR OF THE EUROPEAN SOCIETY OF
CONTRACEPTION AND REPRODUCTIVE HEALTH
Belgrade, Serbia, 18 – 19 September
2009
1. Participant (*obligatory fields)
*Family name:
*First name:
*Title:
*select your title* Prof.Dr. Dr. other
*Title for correspondence:
*select your title* Mrs Ms Mr
Institute:
Department:
*Street/Number:
*Zip code:
*City:
*Country:
“select your country” United States of America United
Kingdom Afghanistan Albania Algeria American
Samoa Andorra Angola Anguilla Antarctica Antigua
and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia
and Herzegovina Botswana Bouvet
Island Brazil British
Indian Ocean Territory Brunei
Darussalam Bulgaria Burkina
Faso Burundi Cambodia Cameroon Canada Cape
Verde Cayman
Islands Central
African Republic Chad Chile China Christmas
Island Cocos
(Keeling) Islands Colombia Comoros Congo Congo,
The Democratic Republic of The Cook
Islands Costa
Rica Cote
D’ivoire Croatia Cuba Cyprus Czech
Republic Denmark Djibouti Dominica Dominican
Republic Ecuador Egypt El
Salvador Equatorial
Guinea Eritrea Estonia Ethiopia Falkland
Islands (Malvinas) Faroe
Islands Fiji Finland France French
Guiana French
Polynesia French
Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard
Island and Mcdonald Islands Holy
See (Vatican City State) Honduras Hong
Kong Hungary Iceland India Indonesia Iran,
Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea,
Democratic People’s Republic of Korea,
Republic of Kuwait Kyrgyzstan Lao
People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libyan
Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia,
The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall
Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia,
Federated States of Moldova,
Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands
Antilles New
Caledonia New
Zealand Nicaragua Niger Nigeria Niue Norfolk
Island Northern
Mariana Islands Norway Oman Pakistan Palau Palestinian
Territory, Occupied Panama Papua
New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto
Rico Qatar Reunion Romania Russian
Federation Rwanda Saint
Helena Saint
Kitts and Nevis Saint
Lucia Saint
Pierre and Miquelon Saint
Vincent and The Grenadines Samoa San
Marino Sao
Tome and Principe Saudi
Arabia Senegal Serbia Seychelles Sierra
Leone Singapore Slovakia Slovenia Solomon
Islands Somalia South
Africa South
Georgia and The South Sandwich
Islands Spain Sri
Lanka Sudan Suriname Svalbard
and Jan Mayen Swaziland Sweden Switzerland Syrian
Arab Republic Taiwan,
Province of China Tajikistan Tanzania,
United Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad
and Tobago Tunisia Turkey Turkmenistan Turks
and Caicos Islands Tuvalu Uganda Ukraine United
Arab Emirates United
Kingdom United
States of America United
States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin
Islands, British Virgin
Islands, U.S. Wallis
and Futuna Western
Sahara Yemen Zambia
Tel:
Fax:
E-mail:
Date of birth:
Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
2. Registration
(*obligatory fields)
(- ESC membership 2009 included in
registration fee-)