REGISTRATION FORM

56th Congress of the Liga Medicorum Homoeopathica Internationalis
Sibiu, Romania, August 29th - September 2nd, 2001

Surname_________________________ Title_______Given name___________________
Organization/Institution_____________________________________________________
Address_________________________________________________________________
Post code________________________ City________________ Country____________
Telephone ___________________ Fax________________ E-mail__________________
Name of accompanying person (as to appear on the name
b a d g e)___________________________________________________________________

Registration fees                                                  450 USD [   ]
One Congress day registration                          150 USD [   ]
Accompanying persons                                        75 USD [   ]
Romanian Evening (30th August 2001)            300 USD [   ]

I have transferred the total amount of __________ USD

Date__________________________ Signature_________________________________

The fees will be paid by bank transfer to
Banca Comerciala Romana, Filiala Sector 2,
str. Popa Lazar nr. 8, Bucuresti, sect.2, ROMANIA
Asociatia ARSMEDICA - Acc. 2511.1.-8760.2

Payment should be made without charges for the beneficiary. Please enclose a copy of the bank transfer voucher. Please make sure to mention your name and the Congress name on the bank transfer. The Congress Secretariat will ONLY accept registrations sent by fax or mail and with a copy of the payment receipt attached.

PLEASE FILL IN AND RETURN TO THE CONGRESS SECRETARIAT BY FAX OR MAIL, WITH THE APPROPRIATE PAYMENT:

As. ArsMedica, 150 Aurel Vlaicu st., Bucharest 72114
Ph/fax: +40 1 212 4655; +40 1 780 6481; +40 1 211 1062;
E-mail: ;