Registration Form

Ms/Mr Title First name Last name Department Organization Address ZIP City Country Phone Fax E-mail

Registration and Fees

I firmly book my participation at the

3^rd International Robin Sequence Consensus Meeting on April 3–4, 2022 (210 Euro for registration before February 1, 2022; otherwise 250 Euro)

Representative of Parent Organisation (Conference Fee: 50 Euro instead of 210/250 Euro)

Social Event in the evening of April 3, 2022 (Further details will follow) (40 Euro)

Post-Conference Workshop “The Tuebingen Approach to RS Treatment” on April 5, 2022 (100 Euro for registration before February 1, 2022; otherwise 120 Euro)

Payment

Please make the payment for registration to the account mentioned below.

Account holder:	Universitaetsklinikum Tuebingen
Bank:	Baden-Wuerttembergische Bank Stuttgart
IBAN	DE41 6005 0101 7477 5037 93
BIC	SOLADEST
Reference	D.33.06852/R.S.C.M. + Name of Participant (Please mention the reference on your remittance, otherwise we cannot allocate receipt of your payment. Thank you!)

Registration becomes effective on receipt of payment. The transfer voucher is your entrance ticket.

Cancellation of the registration possible up to February 1, 2022, for a processing fee of 30 Euro.
Thereafter the complete registration fee will be charged.

Registration deadline: March 15, 2022