Registration Form
Family Name:
First Name:
Speciality:
Institution / Organization:
Mailing Address:
Email:
City:
Country:
State:
Zip
Telephone:
Fax:
Accompanying Person
Family Name:
First Name:

Registration Fees

Active Participant: USD 100.000 (Until August 20th, 2006)
USD 150.000 (Late registration)
Accompanying Person: USD 60.000 (Until August 20th, 2006)
USD 70.000 (Late registration)
Gala Dinner: No. Of Person(s)
Total Amount: (USD)
I want to present a talk YES NO
Topic Title:

Please make bank drafts/transfer payable to: Egyptian Diabetes Center (EDC)
Personal Checks will not be accepted