German Medical Association
Transkript
German Medical Association
German Medical Association of Ozone Application in Prevention and Therapy Member of the “European Cooperation of Medical Ozone Societies” Augusta-Clinic Bad Kreuznach October, 22 – 23, 2004 Ozone in Rheumatology and Myofacial Pain Syndroms APPLICATION FORM Please fill in and send to : Sekretariat “Aerztliche Gesellschaft für Ozontherapie in Praevention und Therapie“ Nordring 8 D-76473 Iffezheim Tel.: 0049-30 46 25 Fax.: 0049-7229-304630 * I shall attend the Ozone Seminar “Ozone in Rheumatology and Myofacial Pain Syndroms” October, 22 – 23, 2004 in Bad Kreuznach, Augusta-Clinic Registration Fee * Member: € 100.00 * Non member : € 140.00 * Accompanying person : € 30,00 Forms of payment: I have transferred the amount of € __________ to Sparkasse Krefeld, bank access no 320 500 00; account no 61 00 74 23. SWIFT: SPKR DE 33 IBAN: DE70 3205 0000 0061 0074 23 Name: ________________________________________________ Address:______________________________________________ Tel/Fax:_______________________________________________ E-mail:________________________________________________