Please return this form to: EAACI 2006 P.O Box 5619 SE-114 86 Stockholm Sweden Phone +46 8 459 6600 Fax +46 8 661 9125 REGISTRATION FORM First name Hospital/Institution Department P.O. Box / Street Address Internal use only Post code and City or State and Zip code Country For Registration and Hotel Information: eaaci2006@ congrex.se Telephone Fax E-mail Capital letters EU VAT No. or Company ID No. Required information EAACI Membership Number E A A C I Deadline for 20 April 2006 Accompanying person(s) No admission to Scientific Sessions First name Demographic Questions A. Do you consider yourself primarily a: Clinician Basic Scientist Academician Clinical Research Coordinator Nurse Office Manager/Administrator Other (please indicate): D. Which of the following type of sessions are you primarily interested in attending: Clinical Issues Translational bench to bedside Basic Science E. What type of patients do you primarily see: Adults Pedriatics Both equally This does not apply to me Make sure that you do not book seminars that run concurrently. B. Primary Area of Expertise: Allergy/Immunology Dermatology Pulmonology Primary Care Other (please indicate): C. Years in practice (please do not include years in training: Currently in training 0 4 5 9 10 14 15 19 20 24 25 + F. Please indicate your gender: Male Female G. Please indicate your age: 21 30 31 40 41 50 51 60 61 70 71 + H. Please rate your computer/internet skills: Novice Intermediate Expert I do not use a computer
Deadline for 19 April 2006 Make sure that you do not book seminars that run concurrently. REGISTRATION FORM Continued First initial Registration Price/person No of EUR Including 20% VAT EUR persons EAACI member (Membership No. must be indicated above) Paid before 9 February 2006 450 1 Paid 9 February - 10 May 2006 550 1 Paid from 11 May 2006 600 1 Non-member Paid before 9 February 2006 600 1 Paid 9 February - 10 May 2006 700 1 Paid from 11 May 2006 750 1 EAACI JMA/Affiliate Junior Member Membership number must be indicated above 250 1 Students Student ID required 250 1 Accompanying person(s) Paid before 9 February 2006 200 Paid from 9 February 2006 250 Breakfast Seminars Meet the Experts Including breakfast 1 st choice Seminar number 30 2 nd choice Seminar number 30 Abstract Book I want an Abstract Book (included in fee) Yes No Allied Health Professionals Programme, 10 June at the Center Vienna Paid before 9 February 2006 180 1 Paid 9 February - 10 May 2006 200 1 Paid from 11 May 2006 220 1 Lunch, 10 June included 1 Yes No Workshops (please choose two) 1 2 3 4 5 6 7 8 9 Sub-total (Page 2) Please mark attendance for events included in the fee and preferred departure time for the Orientation Tour. Social Programme No of persons Vienna OrientationTour (Included in fee) 10 June Yes No Time 12.00 13.00 14.00 Time 15.00 16.00 17.00 Opening Ceremony and Welcome Reception 10 June Yes No (Included in fee) Congress Evening (Included in fee) 13 June Yes No
Deadline for 19 April 2006 REGISTRATION FORM Continued Sub-total (forwarded from page 1) Price/person No of EUR EUR persons First initial EAACI Allergy Run 10 June 20 EAACI Allergy Run t-shirt S M L XL Half Day Tours Including 20% VAT Treasures of the Habsburgs 11 June 14 June 43 Burial places of the Habsburgs 13 June 43 Jewish Vienna 12 June 13 June 48 Music in Vienna 11 June 14 June 46 Footsteps of Mozart 11 June 12 June 51 Old and new masterpieces 11 June 13 June 55 Schönbrunn Palace 12 June 14 June 47 Vienna 1900 11 June 12 June 13 June 55 Southern Vienna Woods 13 June 14 June 37 Full Day Tour Salzburg 12 June 145 Blue Danube Valley 10 June 118 Deadline for social events 10 May 2006 Accompanying Persons' Programme Extra KHM Package - Museum of Fine Arts Included 1 Extra package for delegate EUR 36 Accompanying Person EUR 25 Discount 25 Selected tour: Date: Sub-total this page GRAND TOTAL (pages 2 and 3) Please note that we do not accept personal cheques, company cheques or Eurocheques. All payments should be made in EUR and made out to Congrex, Attn. EAACI 2006. Mark your payment with your name and reference number 602. Please indicate which of the following means of payment you wish to use. American Express Visa Eurocard/Mastercard Bank Transfer: S-E-B, SE-106 40 Stockholm, Sweden, account no. 5553-82 318 95 IBAN no. SE 385000 0000 0555 3823 1895 BIC/SWIFT-code: ESSESESS Banker s Draft Credit card No. Expiry date CCV-security code* * American Express: 4 digits in front of card. VISA and MasterCard: 3 digits at back of card. Please indicate Attn. EAACI 2006, your name and payment reference number 602 on all money transfers to ensure quick handling. Having signed below, I herewith confirm that I have read and am fully aware of the cancellation conditions stipulated in the announcement. I hereby authorise Congrex to debit this credit card account for the total amount due. I also consent to Congrex debiting or crediting my credit card account of any subsequent change(s) to the items booked. Date Name Signature
HOTEL BOOKING FORM Please return this form to: EAACI 2006 P.O Box 5619 SE-114 86 Stockholm Sweden Phone +46 8 459 6600 Fax +46 8 661 9125 E-mail: eaaci2006hotels @congrex.se On-line : www.congrex.com/ eaaci2006 First name Affiliation/Organisation Address Post code or Zip code City Country Telephone Fax E-mail Accompanying Person First name Accommodation Arrival date: / 2006 Departure date: / 2006 Number Single Rooms Number Double Rooms Non-smoking room Late arrival (after 1800 hours) Please indicate your choice of hotel from the list in the preliminary programme: Hotel 1st choice: Hotel 2nd choice: Hotel 3rd choice: (Rates per room, per night and including breakfast and all taxes) JMA I am Female I am Male I wish to share a double room with: (please note that sharing person also must be a JMA) Name: If the requested hotels are already fully booked CONGREX SWEDEN reserves the right to arrange accommodation in an alternative hotel of a similar standard. For a guaranteed booking it is necessary to pay a deposit equivalent to two nights stay. Upon receipt of your payment, the voucher/confirmation with name and address of the hotel will be sent to you. The pre-paid deposit will be deducted from your hotel bill. Cancellation and Change Policy Please inform CONGREX SWEDEN in writing and NOT the hotel about any changes regarding arrival and departure dates. For cancellations before 10 April 2006: No cancellation fees applies, only an administrative fee of EUR 25. CONGREX SWEDEN regrets that the hotel deposit cannot be refunded for hotel cancellations after 10 April 2006. Payment Details All the payments must be made to CONGREX SWEDEN AB in EURO. Payment has been made by: My reservation is guaranteed with credit card: VISA EURO/MASTERCARD AMEX I agree that my credit card details will be forwarded to the appropriate hotel to guarantee the booking and that the hotel may debit my card in the event of any cancellation fees applicable. Card Holder: Card No: Expiry Date: CCV-security code*: I have arranged a bank transfer with a deposit payment equivalent to two nights' stay: free of charge to the recipient to CONGREX SWEDEN AB. Bank transfer: S-E-B, SE-106 40 Stockholm, Sweden, Account no. 5553-82 318 95 IBAN no. SE 385000 0000 0555 3823 1895 BIC/SWIFT-code: ESSESESS * American Express: 4 digits in front of card. VISA and MasterCard: 3 digits at back of card. Having signed below I confirm that I have read and agreed with the cancellation and payment conditions indicated above. Date Name Signature
HOTELS Le Meridien Vienna Opernring 13 AT 1010 Vienna Category A Le Meridien Vienna is directly located on the famous Ringstrasse, only a stroll away from the Vienna State Opera and the Imperial Hofburg Palace. All historical attractions and shopping areas are within walking distance. Near the hotel, guests will find perfect connections with public transport and the Vienna International Airport is only a short 30 minutes drive. Radisson SAS Palais Hotel Parkring 16 AT-1010 Vienna, Category A In 1872 when the city walls were replaced by the grand Ringstrasse, the Palais Leitenberger and the Palais Henckel von Donnersmarck were built as detached family residences. Carefully restored so as to not lose any of their original splendour, these two palaces come together today as the 5 star Radisson SAS Palais Hotel in Vienna. Hotel City Central Taborstrasse 8 The hotel's elegance and lavish architecture will impress you from the moment you enter the bright marble reception hall. A large and varied breakfast buffet awaits you in the climate-controlled Winter Garden with its pyramid skylight. Many sights and famous shopping areas, the underground and the boarding zone for Danube-bound ships are just a short walk. And you can indulge your taste buds at Hotel Stefanie's elegant restaurant "Kronprinz Rudolph" next door. Hotel Royal Singerstrasse 3 AT-1010 Vienna The Hotel Royal has been family-run since 1931 and is situated in a quiet area in the heart of Vienna - right next to St. Stephen's Cathedral and directly on the shopping streets: Graben, Kärntnerstraße and Kohlmarkt. Due to its central location, the Hotel Royal is the perfect starting point for shopping as well as theatre- or opera-evenings. Mercure Grand Hotel Biedermeier Wien Landstrasser Hauptstrasse 28 AT-1030 Vienna Luxury 4 star hotel in typical Biedermeierstyle. The Mercure Grand Hotel Biedermeier is located in a quiet revitalised Biedermeier passage in the heart of Vienna. The atmosphere of the place is permeated by the culture of the old Vienna. Only a few steps from St. Stephan s cathedral, underground and bus stop nearby. Mercure Wien City Hollandstrasse 3 The hotel is located in the centre of Vienna and all interesting and cultural sights are in walking distance. Modern rooms with bathroom, mini bar and Pay-TV. 24 hour Bar. WLAN in public areas and paying parking. Mercure Secession Wien Getreidemarkt 5 AT-1060 Vienna A home away from home, right in the centre of Vienna. Our cosy 4 star hotel is celebrating its 100th anniversary and has been completely renovated to mark the occasion. The Mercure Secession offers a combination of classic Viennese style and modern comfort. Facilities include spacious, air conditioned rooms, bar with Internet terminal, WLAN in the lobby and private parking. The opera, Stephansdom Cathedral, museums, Ringstrasse and Kärntnerstrasse are only a short walk away. Ibis Wien Messe Lassallestrasse 7a IBIS is the right choice without leaving a hole in your budget! Enjoy the relaxing atmosphere. Located close to the International Fair. Nordbahn Hotel Praterstrasse 72 The Hotel is very quiet, clean and centrally located. The staff is very friendly and helpful. Only a 5 min train ride to the Altstadt. Only 5 min walk to the Prater. Hotel Wandl Petersplatz 9 AT-1010 Vienna The hotel, situated in the heart of Vienna, dates back to 1700, when Court Chamber Counsellor and Laxenburg Palace Govenor, Jakob Metz, built this house which was then called "To the Four Seasons". Joseph Georg Daum bought the house in 1851 and converted it to a hotel. Hotel Wilhelmsdorf Kleine Stadtgutgasse 4 The Hotel Wilhelmshof is a 3-star city hotel. It has been family-owned since 50 years. The main building of the hotel is a typical construction of the turn of the last century (built in 1896). Behind the decorative façade you will find a modern, comfortable and wellequipped middle class city hotel.