online registration 9th seminarBy contraception / December 27, 2021 REGISTRATION FORM 9TH SEMINAR OF THE EUROPEAN SOCIETY OF CONTRACEPTION Bucharest, Romania, 21-22 September 2007 1. Participant (*obligatory fields) *Family name: *First name: *Title: *select your title*Prof.Dr.Dr.other *Title for correspondence: *select your title*MrsMsMr Institute: Department: *Street/Number: *Zip code: *City: *Country: Tel: Fax: E-mail: 2. Registration (*obligatory fields) (- ESC membership 2007 included in registration fee) *I am a member of the European Society of Contraception (ESC): please selectyesnot yet *I register for the Seminar as: please selectESC member (paid-up) free of chargenon ESC-member and pay 60 euro I want to take part in the dinner on Friday 21 sept 2007 (50 euro; optional) Please place a tick in the box if you want to participate 3. Method of payment (*obligatory fields) *I pay as follows: please select your method of paymentby credit card (euro/master/visacard)bankers draftbank transfer In case of creditcard payment (eurocard/mastercard/visacard only) fill out next details: (if you don’t like to send your creditcardnumber through internet please print out the pdf registration file or word (.doc) file and send it to the ESC Central Office by mail or fax) You are allowed to charge my select your type of cardEurocard/MastercardVisa card Card number: Exp.date: Name of cardholder: I am willing to send my signature in writing to the ESC Central Office if requested by my creditcard company: selectyesno In that case you will be informed through the ESC Central Office. Note: after submitting this registration form you receive a confirmation of the registration with payment details to print out for your administration!