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Participant

Title *

Dr.

First name *

Last name *

Organisation/Company *

Function *

Address *

City *

ZIP code *

Country *

Email address *

Telephone number *

Arrival date *

Month

Day

Year

Departure date *

Month

Day

Year

Spouse

Title

Dr.

First name

Last name

Special requirements

Please indicate below any special requirements you have (i.e. disabled access, late arrival, dietary requirements, etc.)

Translation

Will you require translation facilities?

Yes

If so, please indicate the language for which you will need translation*

* Please note that translation facilities will only be provided for a MINIMUM of 10 delegates requiring a particular language, but cannot be supplied on an individual basis.

Accommodation

The GIRP Annual Meeting & Conference will take place at Grande Real Villa Itália Hotel & Spa in Lisbon, Portugal. Participants have to book their rooms prior to 15 August 2021 and can do so following this link https://www.book-secure.com/index.php?s=results&property=ptcas29502&arri...
GIRP negotiated rates range from 230€ to 250€ for a single or double room.

Registration Fee

The conference registration fee includes participation in the social programmes but excludes travel and accommodation.

Fees *

Member only rate - 1950 €

Member and accompanying person rate - 2350 €

Non-member only rate - 2250 €

Non-member and accompanying person rate - 2650 €

VAT Number*

* Should you need your organisation's VAT Number featured on the participation invoice, please indicate the number here above.

Registration fees have to be settled prior to the conference by:

International bank transfer

Please make your bank transfer payable to GIRP, bank account number N° 210-0831484-52 at the BNP Paribas Fortis Bank, Place Andrée Payfa-Fosseprez 7, 1170 Watermael-Boitsfort, Belgium.
BIC: GEBABE BB
IBAN: BE64 2100 8314 8452
Reference: Participant’s Name and Surname, GIRP AMC 2021

PayPal

In this case please provide the email address where we can send the payment request.

PLEASE FILL IN THIS FORM PRIOR TO 18^TH SEPTEMBER 2021.

I accept the GIRP event terms and conditions *

Yes

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International bank transfer

PayPal

PLEASE FILL IN THIS FORM PRIOR TO 18TH SEPTEMBER 2021.

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PLEASE FILL IN THIS FORM PRIOR TO 18^TH SEPTEMBER 2021.