September 2, 2010 International Chiropractors Association
 
Chiropractors

PEDIATRICS SYMPOSIUM, LONDON, SEPTEMBER 18-19, 2009
REGISTRATION AND ACCOMMODATION FORM



If you prefer to fill out and mail in a form, please click here for printable version.



 
First Registrant First Name*
        Last Name
Second Registrant First Name*
        Last Name
Professional title
Email Address*
Website Address
Home Address
City
State/Province
Postal Code (Zip)
Country
*Home Phone
 ( )
*Cell Phone
 ( )

REGISTRATION FEES

Registration fees include LUNCH on both days in addition to welcome coffee/pastries,
mid-morning and afternoon refreshments.            

                                           Early Bird before Aug 10                After August 10*
Doctors of Chiropractic                     £310,    €345                             $410,    €445,
ICA/Pediatric Council Members          £290     €323                             £390     €423    
Doctors not on membership database as current will automatically be registered at the regular rate.)
           *Students                             £170     €190                             £ 270    €290

Onsite registrations will be charged an additional £50

*Students (must provide proof of enrollment. Students already graduated with a chiropractic degree and in Master’s programs may not register at this rate, must register at doctor rate.)
Do you want accommodations at Jumeirah Carlton Tower
 Yes     No

Rate:  £199 (single or double) exclusive of VAT and city tax.

Number of Beds
1      2
Arrival Date
Number of Days:
PAYMENT INFORMATION
Total Amount to be Charged (PLEASE FILL IN HERE) £ OR €
CREDIT CARD INFORMATION
Please charge my:* VISA
MasterCard
American Express
Credit Card #*
Exp. Date*

Security Code* (3 numbers on the back of the card)

* For verification purposes, please type in the numbers and letters that you see below then press the Submit button