Registration Form

Evaluation of Medicinal Products in Children
Brussels, 9-10-11 February 2006 and 29-30-31 March – April 1st 2006
At Catholic University of Louvain (UCL) in Brussels, Belgium
REGISTRATION AND HOTEL RESERVATION FORM
Please complete and return this form as soon as possible to the Organizing Secretariat:
Nadine PONS – Pharmacologie Clinique – Hôpital St Vincent de Paul
82, av. Denfert Rochereau –75674 Paris Cx 14 France
Tel: +33.1.40.48.82.22 – Fax: +33.1.40.48.83.28 – E-mail: [email protected]
Please use block letters or type
Please register me to attend the ESDP-Eudipharm Seminar:
Mr
Mrs
Dr
Pr
Family name :.....................................................…………..First Name :……………..............……....
Organization/Company : .........…………………………..................................…………………..............…………..
Position :.....................................…………...........................................................…………..................…………
Address (Street) : ........ ...................................…………..………………………..………………….………….
Postal code : ..........…….City :........ …….….Country :.… ………............……..
Telephone : ...... ………….Fax : .…......…………................................……
E-mail : ……...............………….......…………............……….
PAYMENT :
Course registration fee
Registration fee for academics and non-profit organizations
Registration fee for students, residents, assistants
by enclosed cheque
by bank transfer : on receipt of UCL Debit Note following your official subscription
- Please mention delegate’s name
2500 €
550 €
275 €
ACCOMODATION -
PLEASE CONTACT US FOR MORE DETAILS
February : Modules 1,2,3 :
Arrival date :………..….Departure date :……………..Number of overnight stay :…………………………….....…
March/April : Modules 4,5,6.7 :
Arrival date :……..……….Departure date : ………..Number of overnight stay :………………………..…...…
I shall pay my accommodation upon departure from the hotel as per special negotiated rates, which are per room per night, breakfast,
taxes and service included. Please be informed your reservation can only be processed if your credit card is given to the hotel. Due to
high rate of occupancy in Brussels, we strongly advice to book as soon as possible. Requests will be honoured in the order received.
Signature ………….………..…………………………………
Date ………………………………
NOTE: STUDENTS WILLING TO RESERVE THEIR OWN ACCOMMODATION ARE INVITED TO CONTACT ONE OF THE
ADDRESSES BELOW
BRUXELLES INTERNATIONAL
TOURISME & CONGRES
BRUSSEL INTERNATIONAAL
TOERISME & CONGRES
Hôtel de Ville – Grand-Place - B-1000 Bruxelles
Stadhuis – Grote Markt - B-1000 Brussel
ph : +32-2-513 89 40 - fax : +32-2-513 83 20
e - ma i l : i n fo@ brusse ls to ur is m.be
AUBERGES DE JEUNESSE - JEUGDHERBERGEN - YOUTH HOSTELS –
JUGENDHERBERGEN 2003
HOW TO GET THERE
Gîte d’Etape - Auberge de
Jeunesse Jacques Brel
Metro or Tram till Botanique
or Madou.
30, rue de la Sablonnière
B-1000 Brussels
T.02/218.01.87 - Fax : 02/217.20.05
[email protected] - www.laj.be +
www.cbtj.be
OPEN: 7am - 1am
Parking facilities for 2 wheels
Auberge de Jeunesse Génération
Europe
Metro till Comte de Flandre
All facilities for handicapped
people
4, rue de l’Eléphant
B-1080 Brussels
T.02/410.38.58 - Fax : 02/410.39.05
[email protected]
[email protected] - www.laj.be
OPEN: 7am – 1am
Jeugdherberg Bruegel - IYHF
Heilige Geeststraat, 2
B-1000 Brussels
T.02/511.04.36 – Fax : 02/512.07.11
[email protected] - www.vjh.be
OPEN: 7.00am – 10am /2pm – 1am
PRICE IN €
Single : 23
2 Beds : 18
3-4 Beds : 15
6-14 Beds : 13
Gr: 15 Pers.: -7% except
July & August
Restaurant (60 pers.):
price : 7,80
Pic-Nic : 4,70
Single : 23
2 Beds : 18
3-4 Beds : 15
6-8 Beds : 13
Family rooms:
4 Beds : 45
6 Beds : 72.00
8 Beds : 85
Single : 23
2 Beds : 18
3-4 Beds : 15
5-12 Beds : 13
Gr: 15 Pers.: 15
Meal : 7,80
Pic Nic : 4,70
3 Rooms for handicapped
people.
Closed
20/01/03 !!!
Æ
Walking distance
All facilities for handicapped
people
Non members : + 2,50
per night
Gr: 15 Pers.: 15
Meal : 7,80
Pic Nic : 4,70
LOGEMENT POUR LES JEUNES - LOGIES VOOR JONGEREN - ACCOMODATION FOR YOUNG
PEOPLE - UNTERKUNFT FUER JUGENDLICHE 2003
Espace du Marais - Sleep Well
23, rue du Damier
B-1000 Brussels
T.02/218.50.50 - Fax : 02/218.13.13
[email protected]
OPEN: 24h/24
Centre Vincent van Gogh - CHAB
8, rue Traversière
B-1210 Brussels
T.02/217.01.58 - Fax : 02/219.79.95
[email protected] - www.ping.be/chab
OPEN: 7.30am - 2am
Walking distance from North
and Central Station
Metro : Rogier
All facilities for 50
handicapped people
Single : 25,5035(+WC privé)
2 Beds : 1750(+WC privé)
3 Beds : 16,50
4 Beds : 14,50
+ shower :15
6 Beds : 12
8 Beds : 10,50
During Summer :
sleeping : 8,70
Sheets: + 3,50 obligatory
st
d
Gr : 1 n:16,50, 2 : 13
Meal : 5,95
Pic Nic : 3,45
Metro : Botanique
Bus 65 or 66 from Central
Station
Single : 22
2 Beds : 16
Sheets: + 3,60
Gr: 14
Meal : 8
Pic Nic : 5,75
4 beds : 13,50
6-8 Beds : 12
8-10 Beds : 9,50
ALL PRICES ARE PER PERSON, BREAKFAST AND SHOWER INCLUDED.