registration form

Annual Meeting of the ‘Association Européenne des Illustrateurs Médicaux et Scientifiques’ (AEIMS) and the ‘Medical Artists’ Association of Great Britain’ (MAA)

Confronting Mortality with Art and Science

18 - 20 October 2007, Antwerp, Belgium

Registration Form

Please complete and return this form to AEIMS

AEIMS Secretariat: Pascale Pollier, Tenbossestraat 82, 9660 Brakel, Belgium

E-mail: pascale@artem-medicalis.com Tel: +32 55 42 66 83 / Fax +32 3 216 29 47

Your registration fee may be paid by cheque and sent to AEIMS (see address above)

OR by bank transfer to: FORTIS, Wilrijkstraat 10, 2650 Edegem, Belgium
Account number: 001-0893155-55 IBAN: BE31 0010 8931 5555 – BIC: GEBABEBB

Please do not forget to mention your name and ‘21HMT03’in the reference box.

Your seat at the conference will be definitely reserved upon receipt of your fee.

First name: ……………………………………………………… Surname: ……………………………………………………

Title: ………………………………………. Department: ……………………………………………………

Institution: ……………………………………………………… VAT number: …………………………………..

Address: ………………………………………….………………………………………………………………………..

Postal Code: …………….................City: …..…………………......................... Country: ………………………………………..

Phone: …………………………………………… Email: …………………………………………………………......

AEIMS/MAA member: Yes No AMI/IMI member: Yes No Student: Yes No

Registration Fee The registration fee includes the following: admission to the conference, MAEI-Day and exhibition, welcome reception, programme and abstract book, certificate of attendance, 3 lunches, all coffee & tea breaks.


Registration fee (3 days) Member AEIMS/MAA Member AMI/IMI Non-member Student	Euro 200 Euro 250 Euro 110
Member One Day-------thu fri sat Non-member One Day----thu fri sat Student One Day ----------thu fri sat	Euro 90 Euro 110 Euro 45
Dinner "De Groote Witte Arend"-- thu Annual Dinner --fri Student Annual Dinner --fri MAEI-Day & Exhibition --sat pm Extra abstract Book --EX:......--	Euro 30 Euro 85 Euro 45 Euro 5 Euro 15
Total:	Euro:
Signature:	Date:

For further information and the conference programme please visit our website
http://www.artem-medicalis.com/congres/home.conference.htm