EuroPACS'98 BOOTH REGISTRATION FORM 

                          October 1-3, 1998, Barcelona, Spain

             Radiology Department, Hospital Materno-Infantil Vall d'Hebron  

                  Vall d'Hebron Hospitals, E-08035 Barcelona, Spain


        Booth registration encloses two full meeting registrations (a) and (b)2 


        a)Family Name : ..................................................

        a)First Name  : ............................. Degree :............

        b)Family Name : ..................................................

        b)First Name  : ............................. Degree :............

        Company : ....................................CIF/Tax:............

        Address : ........................................................

        ..................................................................

        City : ................................ PO code : ................

        Country : ........................................................

        E-mail : .........................................................

        Tel  : ......................... Fax : ...........................

                       [  ] Yes, I plan to submit an abstract

        

        [ ] Booth Fee:      300.000 ESP

	    Late Fee, after July 31st, 1998: 400.000 ESP

                            Booth Registration Subtotal: .................ESP



       Hotel Alimara (4*)     Hotel Barcelona (4*)   Hotel Wilson (3*)

         Venue area              City center           City center

      [ ]Single (12200 ESP)  [ ]Single (18000 ESP)  [ ]Single (13500 ESP)

      [ ]Double (15000 ESP)  [ ]Double (20000 ESP)  [ ]Double (17500 ESP)

        

      Hotel Condor (3*)       Hotel Numancia (3*)    Hotel Zenit (3*)

        City center             City center (west)     City center

      [ ]Single (12500 ESP)  [ ]Single (13500 ESP)  [ ]Single (11000 ESP)

      [ ]Double (13500 ESP)  [ ]Double (13500 ESP)

      [ ]Accompanying person (a); Name: .................................. 

      [ ]Accompanying person (b); Name: .................................. 

      Arrival: ../../1998,  Departure: ../../1998,  total: .... Nights

                             Hotel Subtotal: .......................ESP



          (Registration + Hotel) Total Amount:......................ESP

                                (All amounts are in Spanish Peseta, ESP)

     Payment by: 

     [ ] Bank ISSUED cheque in Spanish Peseta (ESP)
     [ ] Bank draft to: 

     Account holder: EuroPACS'98 - Fundacio Vall d'Hebron

     Bank: Banca Catalana (swift: cataesbb), account 015-4444-16-0011500298



     [ ] Charge my credit Card:  [ ] Visa    [ ] Master   [ ] Amex

     Card number:............................... Expiration:..../....  

     Signature:







     Date:..........

                     Fax this form to Organizing Committee: +34 93 2746775

                        or e-mail this form to : jpiquer@ar.vhebron.es

     For further information/particular arrangements contact Org. Committee