REGISTRATION FORM (one form for person) To WORKSHOP
Workshop: Leadership in Academic Medicin. Tax 100 € (includes course material, coffee and lunch) Contact: "David Gordon" gordoncph@googlemail.com Workshop: European specifications of the WFME Global standards for quality improvement in Medical Education. Cost FREE of charge Contact: "Maria Rosa Fenoll" mariarosa.fenoll@gmail.com Workshop: Practical items for the implementation of standards at the postgraduate level. Cost FREE of charge Contact: "Mostafa Seleem" mostafaseleem@hotmail.com IDENTIFICATION FIRST NAME LAST NAME PERSONAL ADDRESS STREET NUMBER ZIP CODE CITY COUNTRY try AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA ASCENSION IS AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA-HERZEGOVINA BOTSWANA BR VIRGIN IS BRAZIL BRUNEI BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REP CHAD CHILE CHINA CHRISTMAS ISLAND COCOS ISLAND COLOMBIA COMORO ISLAND CONGO COOK ISLANDS COSTA RICA CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DIEGO GARCIA DJIBOUTI DOMINICA IS DOMINICAN REP ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ESTONIA ETHIOPIA FAEROE IS FALKLAND IS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA BISSAU GUINEA REPUBLIC GUYANA HAITI HONDURAS HONG KONG-S.A.R. HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY IVORY COAST JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES REP MALI MALTA MARIANA IS MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE IS NORFOLK ISLAND NORTH KOREA NORWAY OMAN PAKISTAN PALAU PALESTINIAN AUTHORITY PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIA RWANDA SAMOA SAN MARINO SAO TOME & PRINCIPE SAUDI ARABIA SENEGAL SERBIA & MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAK REPUBLIC SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SPAIN SRI LANKA ST HELENA ST KITTS & NEVIS ST LUCIA ST PEIRRE & MIQUELON ST VINCENT & BEQUIA SUDAN SURINAM SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA THAILAND THE GAMBIA THE NETHERLANDS TOGO TONGA TRINIDAD & TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS & CAICOS IS TUVALU UGANDA UK UKRAINE UNITED ARAB EMIRATES URUGUAY US VIRGIN IS USA UZBEKISTAN VANUATU VATICAN CITY VENEZUELA VIETNAM WALLIS & FUTUNA ISLANDS WESTERN SAMOA YEMEN YUGOSLAVIA ZAIRE ZAMBIA ZIMBABWE INSTITUTIONAL ADDRESS UNIVERSITY MEDICAL SCHOOL/MEDICAL FACULTY/MEDICAL ACADEMY DEPARTMENT STREET NUMBER ZIP CODE CITY COUNTRY try AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA ASCENSION IS AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA-HERZEGOVINA BOTSWANA BR VIRGIN IS BRAZIL BRUNEI BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REP CHAD CHILE CHINA CHRISTMAS ISLAND COCOS ISLAND COLOMBIA COMORO ISLAND CONGO COOK ISLANDS COSTA RICA CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DIEGO GARCIA DJIBOUTI DOMINICA IS DOMINICAN REP ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ESTONIA ETHIOPIA FAEROE IS FALKLAND IS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA BISSAU GUINEA REPUBLIC GUYANA HAITI HONDURAS HONG KONG-S.A.R. HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY IVORY COAST JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES REP MALI MALTA MARIANA IS MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE IS NORFOLK ISLAND NORTH KOREA NORWAY OMAN PAKISTAN PALAU PALESTINIAN AUTHORITY PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIA RWANDA SAMOA SAN MARINO SAO TOME & PRINCIPE SAUDI ARABIA SENEGAL SERBIA & MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAK REPUBLIC SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SPAIN SRI LANKA ST HELENA ST KITTS & NEVIS ST LUCIA ST PEIRRE & MIQUELON ST VINCENT & BEQUIA SUDAN SURINAM SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA THAILAND THE GAMBIA THE NETHERLANDS TOGO TONGA TRINIDAD & TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS & CAICOS IS TUVALU UGANDA UK UKRAINE UNITED ARAB EMIRATES URUGUAY US VIRGIN IS USA UZBEKISTAN VANUATU VATICAN CITY VENEZUELA VIETNAM WALLIS & FUTUNA ISLANDS WESTERN SAMOA YEMEN YUGOSLAVIA ZAIRE ZAMBIA ZIMBABWE TELEPHONE (Day) (Country code/City code/number) FAX (Country code/City code/number ): E-mail: UNIVERSITY/MEDICAL SCHOOL MANAGEMENT POSITION: Cancellation Cancelations must be sent in writing to AMSE 2008 by e-mail amse2008@ub.edu or by fax 34-93-4035254. If a cancellation is received by 5 May 2008, the registration fee minus and administration charges of 30% wil be refunded after the conference. If a cancellation is received after the 6 May 2008 and/or the partipant fails to attend, the entire registration fee must be paid. Substitutes wil be accepted at any time provided that amse 2008 is informed to the change For more information amse2008@ub.edu
Workshop: Leadership in Academic Medicin. Tax 100 € (includes course material, coffee and lunch) Contact: "David Gordon" gordoncph@googlemail.com
Workshop: European specifications of the WFME Global standards for quality improvement in Medical Education. Cost FREE of charge Contact: "Maria Rosa Fenoll" mariarosa.fenoll@gmail.com
Workshop: Practical items for the implementation of standards at the postgraduate level. Cost FREE of charge Contact: "Mostafa Seleem" mostafaseleem@hotmail.com
FIRST NAME
E-mail:
Cancellation Cancelations must be sent in writing to AMSE 2008 by e-mail amse2008@ub.edu or by fax 34-93-4035254. If a cancellation is received by 5 May 2008, the registration fee minus and administration charges of 30% wil be refunded after the conference. If a cancellation is received after the 6 May 2008 and/or the partipant fails to attend, the entire registration fee must be paid. Substitutes wil be accepted at any time provided that amse 2008 is informed to the change For more information amse2008@ub.edu
Cancellation
For more information amse2008@ub.edu
For more information
amse2008@ub.edu