Registration and Accommodation Form
The 15 ^thAnnual Conference of

The Egyptian Society of Infection Control
(Infection Control Every Body 's Bussiness)

المؤتمر السنوى الخامس عشر للجمعية المصرية لمكافحة العدوى

"مكافحة العدوى مسؤولية الجميع"

1th - 4th of December, 2006

Family name:

First name:

Institute:

Department:

Position:

Address:

City:

Country:

Telephone:

Mobile:

Fax:

Email:

Accompanying person Yes No

Full Name(s)

Arrival Date :

Airline :

Flight No :

Departure Date:

Airline :

Flight No :

Payment

fees	Payment before 15^th Sep,2005		Payment after 15^th Sep,2005		Amount to be paid
Registration fees for Participant citizens	ESIC member	Non-ESIC member	ESIC member	Non-ESIC member
	350 LE	400 LE	400 LE	450 LE
Registration fees for Participant non-citizens	200 US $		250 US $
Registration fees for accompanying person(s)	150 US $		200 US $
Accommodation single occupancy	90 US $		110 US $
Accommodation double occupancy	105US $		125 US $
Transportation	50US $
Total amount to be paid

The total amount of will be paidby(name) Please indicate below which means of payment you will use.

Credit card

Type of card:	Visa Master Card
Credit Card no. :
Expiry date :
Last 3 digits on reverse of card :
Cardholder's name:
Cardholder's signature (essential):
Approval No.( official use only ):

Cash, Bank transfer or Bank cheque