R e g i s t r a t i o n   F o r m


Please select the name of the conference

 

                 
  Registration
Title
Family Name First Name
Name on Badge Institution/ Company
Address Division / Department
City Postal Code
State / Province Country
Phone Fax
E mail   
I will present Paper Yes No
  Accompanying Persons
Title
Family Name First Name
Title
Family Name First Name
  Registration Fees
Member
Non Member 
Non Jordanian Member
Residents
Accompanying Persons - Intern Students and nurses
(For Scientific Program only)

  Hotel Registration
Arrival Date     Carrier / Flight No.     Time
Departure Date Carrier / Flight No. Time
    
Please Tick Hotels Rating
Marriott -Dead sea 5*
Movenpick -Dead sea 5*
Le Meredien 5*
Le Royal 5*
Inter Continental 5*
Grand Hyatt 5*
Holiday Inn 4*
Marmara 3*
Al-Qaser 3*
* All above rates are inclusive ( Tax. Service and Breakfast )
     
  Congress Tours
Tours Date No. of Persons
T1
T2
T3
T4
T5

 

 Airport Transfer
Meet and Assist at the airport and transfer to hotel.
Airport to Hotel (20$) Hotel to Airport (20$)
Date Date
Pick up time Drop off time
        

- Payment should be paid in US Dollars either by telegraphic transfer or by Bank Draft in favor of the Arab 
  Organizers Co.
- Credit Cards and personal cheque are not accepted.

 

            

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