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Registration to Third Magnetic Resonance Balkan Outreach Program

22-24 May 2014 Sheraton Hotel & Convention Center - Ankara/Turkey

Personal Information Address Information
Name* Phone*
Last Name* Mobile
Title* Fax
Organization E-Mail*
Department Confirm E-Mail*
    City
    Country
    Address
    Postal Code
Registration Fee
Price
Full Registration
100€
Student Registration 50€

*Any registered student (including graduate and undergraduate students) qualify for student registration rate. 

Not: Bu programa Türkiye'den katılacak olan öğrencilerden kayıt ücreti alınmayacaktır. Bu program Türk Manyetik Rezonans Derneği (TMRD) tarafından desteklenmektedir, ve TMRD 19. Yıllık Toplantısı katılımcılarına ücretsizdir. 

*** VAT is included in the above fees TOTAL AMOUNT:
Payment Method
I want to pay with money transfer I want to pay with credit card  
Bank information for registration & accommodation fees
Bank Name: Garanti Bank Please charge the total amount from my credit card (details below)
Branch: Kavaklıdere I want to fax my credit card details to the Organization Secretary.
Branch No: 075 Credit Card: Master Visa
American Exp. Euro Card
Account Name: BilkonTurizm (MRBALKAN) Bank Name:
Account No: 9081230 (EURO) Credit Card N0:
IBAN Euro TR25 0006 2000 0750 0009 0812 30 Expire Date: /
Swift Code:   Secure Code (CVV2):