Last Name              First Name  

 Title:   Prof.   Dr.   Mr.   Mrs.   Ms.

Department             Institution  

City              Country  

Mailing Address:

No.             Street  

City              Province/State  

Postal Code/Zip              Country  

Phone              Fax  

Email  

Arrival Date:               Departure Date:   

Hotel Priority:        1)      2)      3)        

Number of Persons                I will be sharing with:  

Last Name              First Name  

Last Name              First Name  

Payment
Hotel deposit 1 night per room should accompany this form

Payment options

Option 1: Bank Draft

The bank draft must be in US currency and made payable to the SIU Uro-Oncology Meeting 2003. Your name and address must be clearly indicated on the back. Bank charges are to the debit of the person transferring the money.

Option 2: Bank Transfer

The amount in question should be transferred to the following bank account:

MISR INTERNATIONAL BANK
54 El Batal Ahmed Abdel Aziz
El Mohandeseen, Cairo, Egypt

Account no.: 6064109
Account holder: SIU Congress 03 Soc. Int. D Urologie
Swift Code: MIIBEGCX005

Option 3: Credit Card

For security reasons participants wishing to pay with credit card can send their credit card details to the following

SIU Uro-Oncology Congress Secretarit
P.O. Box 2477 El-Horria, Heliopolis
Cairo 11361, Egypt
Phone: ++20-2-6241706 or ++20-12-2137100
Fax: ++20-2-6241719 or ++20-2-6709709
Email: SIU2003@uroegypt.com (copy to: i.steppert@lycos.com)

Please , note that the transaction will appear on your statment under the name of MISR INTERNATIONAL BANK. Should there be an error in the sum of the section totals above made by the registrant, the Congress reserves the right to charge the correct total amount.

Please note: No personal cheques are accepted.