8th International Symposium on Maritime Health

Notes: Confirmation will be issued for all registrations.
Registrations will be accepted if accompanied by the appropriate payment.
If you want to share a room with another delegate please enter his name
under "Accompanying person", and he has to do the same on his registration form.

If paying by Bank to bank transfer please submit the form electronically.
<*dv_0*>Payment informations are available here.

If paying by credit card, you must download form in PDF here, print it out
and send it by fax to number +385/51/312-333 or send it by post to
8thISMH - Techinical and General SECRETARIAT,
RI-AK, Verdieva 6, 51000 Rijeka, Croatia.

PARTICIPANT

Title

First Name and Middle Name

Last Name
Organization/Company

Mailing Address

Postal Code

City

Country

Telephone Number (Country Code/Area Code/Number)

Fax Number (Country Code/Area Code/Number)

E-mail

Passport Number

Accompanying Persons

First Name and Middle Name

Last Name

Passport Number

<*dv_2*> First Name and Middle Name

Last Name

Passport Number

Other Info

Conference Registration Fee
(please tick)

Delegate - EUR 330
No. of persons
Accompanying Person - EUR 150
<*dv_3*>No. of persons

Accomodation On Board MS Dalmatia (please tick)*

Single Occupancy - EUR 720
<*dv_3*>No. of persons No. of rooms
Double Occupancy - EUR 560
<*dv_3*>No. of persons No. of rooms

* all rooms are double-bed. Prices are per person, for 5 nights and are including all meals - on board or on the shore - according to the program of the conference

I am interested in pre/post conference tour:

Preconference Venice
<*dv_1*> Postconference Venice
Postconference Dubrovnik - Medjugorje

Airport Transfer (Zagreb - Rijeka and Venice - Airport - Venice)

One way (Airport - MS Dalmatia) - EUR 10 <*dv_3*>No. of persons
Roundtrip (Airport - MS Dalmatia - Airport) - EUR 20 <*dv_3*>No. of persons

Flight information

Arrival/Check-in Date

Fligh No. & Arrival Time

Departure/Check-out Date

Fligh No. &Departure Time