Cohehre registration form

Please fill in the form to register for the Cohehre conference 2012

First name  Last name  University/Institution  Address  Town  Zip code/ Postal code  Country  Phone contact  E-mail contact  Degree programme  Nursing   Midwifery   Physiotheraphy   Occupational theraphy   Radiography   Speech theraphy   Other  If other, please specify  I am (please choose max. 2 options)  Dean   Lecturer   International coordinator   Student   Other  If other, please specify  Type of registration  Euro 375 - Early bird staff (Latest March 7) Euro 475 - Normal fee Euro 950 - Non-member fee Euro 200 - Taster fee Euro 200 - Early bird student (Latest March 7) Euro 250 - Student fee Free student (1 per institution) Free host school participants (max. 10) Euro 150 - Staff host school Euro 100 - Host school fee student programme Euro 150 - Cancellation Will you attend Tuesday's pre-conference (Euro 150)?   No Yes Do you wish to reserve a bus-pass for 4 days of public transport in Aalborg (Euro 15)  No Yes Will you attend the closing dinner?  No Yes Will your spouse attend the closing dinner (Euro 60)  No Yes Allergies and special food indications  You have the possibility of participating in a free of charge cultural event. This is of course optional. Please choose which event you wish to participate in. Please note that there is a limit of participants to each event. Cultural events - April 19, evening (Historical tour is now fully booked) Guided tour at 'Nordkraft' - Aalborg's old power station. Today, a rendezvous for Aalborg citizens.   Guided tour to activity spots in the city centre of Aalborg   NO LONGER AVAILABLE - FULLY BOOKED Guided historical tour in the city centre of Aalborg. Cohehre is pleased to invite you to a one-day excursion to Skagen - the northernmost point of Denmark. (Programme for the excursion can be found on the website) - Min. 20 participants. Do you wish to participate in the excursion to Skagen? (Euro 135)  No Yes Final additional comments