Please complete this form and return it to

Elisabeth Erhardtsen

University of Southern Denmark, Language and Communication

Campusvej 55, DK 5230 Odense M

fax (45) 65 93 24 83, Erhardtsen@language.sdu.dk.

 

Conference on Medical Interaction
NAME: 

Address:

Fax: 

E-mail address:

The conference fee is Dkr. 1.000 (about 130 EURO). The fee covers coffee, conference dinner, lunches and a reception, as well as materials. Discount registration Dkr. 200 (about 25 EURO). Discount registration will only cover participations and neither conference dinner nor lunches.  

Type of registration:

[ ] Full registration

[ ] Discount registration; reason:

0 retired 0 unemployed 0 poor country 0 student

 

Signature, title and affiliation of professor affirming student status:

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