(Emergency FAX/Mail) Delegate Registration Form

This is not for online-submission but only for registration via fax/mail. Use only if electronic registration at http://yi.com/mednet99 is not possible!

Print out and fill in this form and mail/fax it with your credit card information, cheque or cash to:

 

Mednet99 Congress Secretariat
C/o Universität Heidelberg,
Abt. Klinische Sozialmedizin
G. Eysenbach
Bergheimerstr. 58
69115 Heidelberg
Germany

 

Fax +49-6221 56 55 84

 

Personal Details:

  Title:   Initials:
First name
Surname/ Family Name:  
Company/ Institution:  
Address:  
State/ Province:  
Phone:  
Country:  
Fax:  
City:  
Postal/Zip Code:  
Email:  

Registration Details

All registration fees include

conference material

free reception on the opening ceremony (Saturday, Sept. 18th, 1999)

a light lunch, coffee and tea on Sunday, Monday and Tuesday.

Not included is lunch on Saturday - if you want to participate on Saturday in a tutorial/workshop, please do not forget to order an extra lunch on Saturday (below).

Discounts

Reduced fees are available for undergraduate students providing evidence of their status. To qualify for student rates you must include a written document confirming your status (e.g. from the student affairs office of your school/university or a copy of your student ID).

Postgraduate students only qualify for reduced rates if they provide convincing and written evidence that they have to pay tuition or live on a low-income fellowship.
Member rates are available to fully paid-up members of the Society of the Internet in Medicine (SIM). If you are not a member of SIM, you should consider joining as it is a cost-effective way to reduce your registration fee.

Fee reduction in special cases

In individual cases we may reduce or waive the participation fee for participants from developing or Eastern European countries upon written request. This decision will be made on a case-by-case basis by the Local Organizing Committee. To apply for reduction or waiver of the fee, participants are required to submit a written request (you may use the comments field at the end of this form), explaining why they need financial support and stating at least
- the amount they want to have reduced
- the reasons why they cannot pay the full registration fee
- evidence for the reasons given, for example status of income, written confirmation of the department head that there is no money from grants and external funding to cover the participation fee etc.
The decision to reduce the participation fee will be made by the Local Organizing Committee and is final. It heavily depends on the amount you want to have reduced (as full waiver of the participation fee is more hard for us to agree upon than a partial reduction) and on your ability to convince us (including the evidence provided) that you can really not pay the full amount.

Conference Registration (Sunday-Tuesday)

To save money, we recommend to become a SIM member prior to registration! Contact Stephen Keevil from the SIM.

Full registration (Sun-Tue)

Before Sep 15th, 1999
SIM Member*

EUR 295

 
Non-Member

EUR 450

 
SIM Member (student)*

EUR 110

 
Non-Member (student)

EUR 190

 
No full conference registration
(tutorial registration, social event, press ticket or day tickets)

-

 
Single day registration (no reduction for SIM members/Students)  
Day ticket Sunday

EUR 150 

Day ticket Monday EUR 150 
Day ticket Tuesday EUR 150 
 

Subtotal for conference registration
EUR:

Please tick the appropriate box. Please note that registration fees do not incur VAT. All figures given in Euro (EUR) - see currency calculator e.g. at http://www.bloomberg.com/markets/currency/currcalc.cgi/curcalc.html

*SIM Members: I am a fully paid-up member of the Society for the Internet in Medicine.
My membership number is:
(You don't know? Please don't ask us, but Stephen Keevil (mailto:s.keevil@umds.ac.uk) from the SIM)
*Important: If you register as SIM member, you have to be a SIM member at the time of your registration. No refunds are possible if you become a SIM member after registration or at the time of the congress. If you register as "SIM member" without providing a valid membership number in the box above, we will have to charge you the regular fee.

Saturday: Teaching workshops (tutorials)

I wish to attend the following tutorials (held on Saturday, 18th) (please tick the appropriate boxes).
Tutorials can be booked in addition to or independently from the main congress on Sun-Tue. No student discounts are possible. Details about the tutorials including curriculum and tutors can be found at http://yi.com/mednet99/tutorials.htm.

All tutorials/workshops include coffeebreaks and snacks, but no lunch. Please do not forget to order your Saturday-lunch extra (below).

  Code Titel, author Duration, Costs Sum Euro
S1/DE Satellitenkongreß "Internet in der Medizin" (German track - in German only) 4 hrs / 25 Euro
T1/EN Medline and beyond: finding high quality health and medical information on the Internet 4 hrs / 150 Euro  
T1/DE Medline und mehr: Medizinische Informationen suchen und finden im Internet 4 hrs / 150 Euro  
T2/EN How To Create Dynamic Interactive Medical Websites 3 hrs / 100 Euro  
T3/EN Wavelet-based coding of medical data: JPEG2000 and the future of image compression 3 hrs / 75 Euro  
T4/EN Money Matter$: Assessing and implementing advertising and sponsorship opportunities on your medical website 2 hrs / 75 Euro  
T5/DE Effektive Web Page Design Techniken für Ärzte: Einführung in HTML 3 hrs / 100 Euro  
T5/EN Effective Web Page Designs for Health Care Professionals: Understanding HTML enough to try it Yourself! 3 hrs / 100 Euro  
T6/EN Internet and Psychiatry 2 hrs / 50 Euro  
T7/EN BSCW: a Web-based groupware system for international collaboration 2 hrs / 50 Euro  
T8/EN XML: Introduction, overview and practical applications 3 hrs / 100 Euro  
   

Subtotal for teaching workshops  

EUR:

Social Events and Lunch

Numbers are limited at all of the social events, and bookings will be taken on a first-come first-served basis. You are advised to register early to avoid disappointment. Please insert the numbers of tickets required as appropriate.

Code

Event

Price per ticket

Number of tickets

 Sum Euro

Sat, 18th, 14:45h-16:30h
Guided City Tour
Caution - overlaps with tutorials: Do not book this if you take a tutorial

EUR 5

 

  

Sat, 18th, 20h (after reception)
Welcome party with historical dinner -Highlight-

EUR 45

 

  

Sun, 19th, 18:30h-19:00h (preceding the Banquet)
Guided tour through the Heidelberg Castle (inside)

EUR 5

 

  

Sun, 19th, 19h- open end
Banquet Dinner in the Heidelberg Castle -Highlight-

EUR 55

 

  

Mon, 20th, 18h-19:30h
Neckar riverboat cruise

EUR 10

 

  

Tue, 21st, 17h
Guided City Tour
Caution - overlaps with the SIM General Assembly: Do not book this if you plan to attend the GA

EUR 5

 

  
 

Subtotal for social events

 EUR:   

Lunch / Dinner requirements

Lunch is included in the conference fee for all conference days (Sun-Tue), please specify if you have any special dietary requirements (will also be taken into consideration for the dinner, if you participate in the social events):

vegetarian

or other special dietary requirements: .

If you participate in one or more pre-congress tutorials or the German track on Saturday, we suggest to order the Saturday lunch (at the conference venue):

lunch on Saturday: EUR 10

Hotel

No hotel reservations can be made using this form. For hotel reservations please contact Matthew Incentives (Mathew-Incentive@t-online.de).

Extra comments

Use this box to transmit important communications regarding your registration to the Congress Secretariat.

 

Payment

Grand total (sum of subtotals) EUR:

Please indicate how you want to pay:

 

 

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