Hand Course and Principles Course
Davos, Switzerland
Advanced, Experts Meet Experts, Maxillofacial, and Spine Courses
Davos, Switzerland
Sunday, December 9 - Friday, December 14, 2001
(Travel dates: Friday, December 7 and Saturday, December 15)
Registration is limited. Do not consider yourself registered in the course until official confirmation is received. Registration will not be accepted unless tuition fees are included with registration form.
(Please type or print clearly for official course listing and course certificates)
Name: __________________________________________________
Attending: ___ Resident: ___ PGY Year: ___
Degree(s): __________________________________________________
Social Security No.: __________________________________________________
(for documentation purposes only)
Citizen of (Country): __________________________________________________
Hospital Affiliation: __________________________________________________
Home Address:
City: __________________________________________________
State: __________________________________________________
Zip: __________________________________________________
Phone: (Office) ___________________________________
Home Phone: ___________________________________
Fax: ___________________________________
Email: __________________________________________________
Guest's Name: __________________________________________________
Have you attended an AO ASIF Basic (Principles) Course? Yes ___ No ___
Have you attended an AO ASIF Comprehensive Spine Course? Yes ___ No ___
Please enclose copy of certificate(s)
Orthopaedic ___ Neurosurgeon ___
How many spine osteosynthesis have you performed? 0 ___ <60 ___ >60 ___
Are you an orthopaedic surgeon or neurosurgeon with a specialized spine practice? Yes ___ No ___
Oral and Maxillofacial ___ Otolaryngology ___ Plastic ___ Other ___
Do you have any special needs? Yes ___ No ___
__________________________________________________
COURSE REQUESTED
(Please refer to Course Descriptions for detail.)
December 1-6
( ) Hand Course | CHF 1900 |
( ) Principles (Orthopaedic) | 1500 |
December 9-14
( ) Advanced (Orthopaedic) | CHF 1800 |
( ) Maxillofacial Course | 1900 |
( ) Spine Interactive I | 1900 |
( ) Spine Interactive II* | 1900 |
( ) Banquet ticket (per person) | 80 |
( ) Experts Meet Experts (Choose one per day) |
CHF 1500 |
MONDAY | ( ) Locking Compression or ( ) Computer Presentation |
TUESDAY | ( ) Osteotomy I or ( ) ARI/ADI |
WEDNESDAY | ( ) Osteotomy II or ( ) Proximal Humerus |
THURSDAY | ( ) Pelvis and Acetabulum or ( ) Wrist |
FRIDAY | ( ) Foot and Ankle or ( ) Navigation |
For estimated US dollars, see Course Description
Single Room: ___ | Double Room: ___ |
Arrival Date: ______________ | Departure Date: _______________ |
Reservation Remarks: ________________________________________________________________________
________________________________________________________________________
Category: | Double Room w/ bath breakfast | Single Room w/ bath breakfast |
Double Room w/ bath halfboard | Single room w/ bath halfboard |
A *****/**** | CHF 140 | CHF 160 | CHF 164 | CHF 184 |
B **** | CHF 125 | CHF 145 | CHF 149 | CHF 169 |
C *** | CHF 95/105 | CHF 115/125 | CHF 113/123 | CHF 133/143 |
D ***/** | CHF 90 | CHF 110 | CHF 108 | CHF 128 |
E**(without bath) | CHF 73 | CHF 86 | CHF 91 | CHF 104 |
All prices in Swiss Francs per person and per day.
As a guarantee for your hotel booking, we will need your credit card number, which will be passed to the hotel. No advanced payment needed; you will settle your bill at check out. In case of non-arrival the room may be charged to your credit card.
Payment by Check
Bank: Credit Suisse, Davos-Platz
Acc. No. 518.000-41-9/Bank code: 4187
The registration is validated only when the tuition fees have been paid. Registrations will be accepted in chronological order. Early booking is advisable. Your registration will be confirmed after receipt of the registration form and the payment.
A check can be sent with the registration form. The name of the participant must be clearly indicated on the check.
Charge my credit card:
( ) Visa ( ) Mastercard ( ) American Express
Card Number________________________________
Expiration date_______________________________
Signature __________________________________
(all credit card orders must be signed)
Please return completed Course Registration Form and payment to:
AO Course Secretariat
Clavadelerstrasse
CH-7270 Davos-Platz
Switzerland
Phone: 41 81 414 27 20
Fax: 41 81 414 22 84
E-mail: courses@ao-asif.ch
During the courses:
Convention Center
CH-7270 Davos-Platz
Phone: 41 81 414 61 11
Fax: 41 81 414 64 26
The course Registration Deadline is August 31, 2001
AIRFARE
Gateway City | Price per person |
Atlanta | $693.36 |
Boston | $625.86 |
Chicago (O'Hare) | $691.36 |
Los Angeles | $790.86 |
Miami | $656.99 |
New York (JFK) | $625.86 |
Newark | $625.86 |
Washington, D.C. (Dulles) | $674.86 |
Montreal | $770.26 |
Passenger Facility charges may apply. Airfares are subject to change based on availability at time of booking and are not guaranteed until ticketed.
Airfares are non-refundable. The exceptions are: hospitalization of the passenger, death of the passenger or an immediate family member. Upon receipt of proper documentation, the airfare will be refunded less applicable penalty. Ask about children's rates.
If Swissair is offering lower airfares at the time of purchase, World Travel will offer passenger the lowest available fare.
Name: __________________________________________________________________
Address: ________________________________________________________________
Phone Number: ___________________________________________________________
Email Address: ___________________________________________________________
Special Requests: _________________________________________________________
________________________________________________________________________
Please add my Frequent Flyer account number to my air reservation:
Airline Name____________________Account Number_________________________
Please make checks payable, in U.S. funds, to:
World Travel Incorporated
Amount Enclosed:
$__________________________________
Charge my credit card:
( ) Visa ( ) Mastercard ( ) American Express
Card Number________________________________
Expiration date_______________________________
Signature __________________________________
(all credit card orders must be signed)
Please return completed Air Reservation Form with payment to:
World Travel Incorporated
Attn.: Group Department-Davos 2001
1724 West Schuylkill Road
Douglassville, PA 19518
Phone: (800) 867-2970
Fax: (610) 327-8874
List names of passengers (no nicknames), passport number, date of birth for yourself, spouse, guests, and children. Please fill in originating city, gateway city, departure date and return date.
Please type or print clearly.
1.
Name: _______________________________
Passport Number: _________________________
Birthdate:________________
Originating City: __________________ Gateway City: _____________________
Departure Date: __________________ Return Date: __________________
Seating Preference: ( ) Window ( ) Aisle
2.
Name: _______________________________
Passport Number: _________________________
Birthdate:________________
Originating City: __________________ Gateway City: _____________________
Departure Date: __________________ Return Date: __________________
Seating Preference: ( ) Window ( ) Aisle
3.
Name: _______________________________
Passport Number: _________________________
Birthdate:________________
Originating City: __________________ Gateway City: _____________________
Departure Date: __________________ Return Date: __________________
Seating Preference: ( ) Window ( ) Aisle
4.
Name: _______________________________
Passport Number: _________________________
Birthdate:________________
Originating City: __________________ Gateway City: _____________________
Departure Date: __________________ Return Date: __________________
Seating Preference: ( ) Window ( ) Aisle
5.
Name: _______________________________
Passport Number: _________________________
Birthdate:________________
Originating City: __________________ Gateway City: _____________________
Departure Date: __________________ Return Date: __________________
Seating Preference: ( ) Window ( ) Aisle