12th ICID

12th ICID

Welcome
Congress Committees
Commercial Exhibition
Financial Assistance
Awards
Scientific Program
(updated 13 July 2005)
- Plenary Lectures
- Symposia
- Confirmed Speakers
Abstract Guidelines
Congress Organization
Registration
Hotels
- List of Hotels
- Map of Hotels
Tours
Sponsorship
General Information

Online Forms

Conference Registration
Hotel & Tours Reservation

PDF Forms

Preliminary Program
Conference Registration
Hotel & Tours Reservation

12th ICID - Lisbon, Portugal - June 15-18, 2006

Registration Form
Your registration form will be automatically sent by e-mail.
Registration is handled by Top Atlântico Operated by TopTours. Please complete the form and click "Submit" at the end.

PARTICIPANT

Mr. Ms. Prof. Dr.

Last Name*

First Name*

Department

Institution

Address at work*

City*

State

Postal code*

Country*

E-mail*

Phone*

Fax

Are you member of a National Society?
If yes, please indicate the Society:

Fields marked with an * are required.

ACCOMPANYING PERSON(S)

Last Name

First Name

Last Name

First Name

REGISTRATION FEES

	Before/On April 15, 2006	After April 15, 2006
Delegate/Regular member*	€ 350,00	€ 450,00
Delegate/Non-member	€ 400,00	€ 500,00
Students**	€ 175,00	€ 225,00
Accompanying persons	€ 75,00	€ 100,00
** Please send proof of student status by mail to lisboa.congress@topatlantico.pt or by fax to the fax number + (351) 218 925 406. * To be eligible for the membership discount REGULAR MEMBERS must include their ISID membership number displayed on their ISID membership card.

ISID membership card number

Expiration date

/ /

PAYMENT


	Swift Bank Transfer Swift bank transfers must be made without charges to the beneficiary in Euro, payable to: "ICID Registration" Account number: 0960 2859 0001 IBAN PT50 0007 0096 00028590001 57 SWIFT/BIC code: BESCPTPL Bank: Banco Espirito Santo Rua Alexandre Herculano No. 38/6° 1269-161 Lisbon, Portugal Please send copy of your bank transfer by mail to lisboa.congress@topatlantico.pt or by fax to the fax number + (351) 218 925 406. Please make sure that your name and address appear clearly on all payment documents. Bank transfers received without the name of the participant cannot be processed. Bank drafts and checks will not be accepted for payment. ISID and Top Atlântico are not responsible for payments not sent as stated above. DO NOT COMBINE REGISTRATION FEES AND HOTEL PAYMENTS ON SAME BANK TRANSFER. SEPARATE PAYMENTS ARE REQUIRED.
	Credit Card

CANCELLATION POLICY

The registration fee less EUR 75,00 administration fee will be refunded for any cancellations received on or before May 8, 2006. Any cancellations received after this date will not be considered. All approved refunds will be issued within 60 days after the Congress. Only written requests will be accepted.

LIABILITY

Personal travel insurance is strongly recommended, as the ISID and Top Atlântico Operated by TopTours act as agents only in securing hotels, transport and travel services and in not event shall be liable for acts or defaults in case of injury, damage, loss, accident, delay or irregularity of any kind whatsoever during arrangements organized through contractors or the employees of such contractors in carrying out services. Hotel and transportation services are subject to the terms and conditions under which they are offered to the public in general. The Organizing Committee reserves the right to make changes where deemed necessary, without prior notice to parties concerned. All disputes are subject to the Portuguese law. We kindly ask you to authorize us by your signature to use all registration data given in this form for a computerized handling of the Congress.
Demographic Information
Education:	Primary job-related activity:	Areas of interest:
MD (or equivalent) PhD Other	Administration Teaching Research Clinical Microbiology Clinical Infectious Disease Care Other	Antimicrobial and Antiviral Resistance Bacterial Infections Clinical Microbiology Drug/Diagnostic Development Epidemiology and Public Health Genetics/Immunology HIV Mycology Mycobacteriology Nosocomial Infections Parasitic Infections Vaccines Viral (non-HIV) Infections Other

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12th ICID Congress Secretariat:
Top Atlântico Operated by TopTours - Congress Department
Av. Dom João II, Lote 1.16.1 - 1990-083 Lisbon - Portugal
Phone: + (351) 218 925 405 Fax: + (351) 218 925 406
E-mail: lisboa.congress@topatlantico.pt