Registration Form

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

Registration and Fees

Please tick as appropriate!

I firmly book my participation at the

Pre-Conference Workshop “The Tuebingen Approach to RS Treatment” on October 9, 2021 (100 Euro for registration before August 1, 2021; otherwise 120 Euro)

3^rd International Robin Sequence Consensus Meeting on October 10 and 11, 2021 (210 Euro for registration before August 1, 2021; otherwise 250 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 August 1, 2021, for a processing fee of 30 Euro.
Thereafter the complete registration fee will be charged.

Registration deadline: September 15, 2021