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Lecture 1 ...............................................................
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from my computer
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from ESTRO computer
Lecture 2 ...............................................................
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from my computer
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from ESTRO computer
Lecture 3 ...............................................................
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from my computer
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from ESTRO computer
Lecture 4 ...............................................................
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from my computer
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from ESTRO computer
Lecture 5 ...............................................................
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from my computer
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from ESTRO computer
Lecture 6 ...............................................................
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from my computer
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from ESTRO computer
FACULTYREPLY FORM
ESTRO course on
Evidence Based Radiation Oncology
, Porto, Portugal, 12 – 17 June 2016
Please return the completed form t
o makkers@estro.org by 1 April 2016
Please complete your details/requirements:
Personal information (as printed on your passport)
First name: ...................................................
Family name: ............................................................
Dietary requirements: ..................................
Physical requirements: ................................................
Travel & insurance
Travel costs are covered by ESTRO at economy rates.
I will arrange for my own travel to Porto and back.
Only book your travel after having received written
approval by the ESTRO office. Costs can be claimed back based on actual invoices /original receipts and through
the reimbursement form that you will receive onsite in Porto.
Please book my travel
I will travel by:
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Train /
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Plane
Departure: from (city/country) ....................................................... and day ............ June 2016
Return: to (city/country)
....................................................... and day ............ June 2016
I have my own medical, travel and personal insurance
I would like to take out the ESTRO travel insurance since this is not offered by my regular employer
(unlimited medical and repatriation expenses for the time spent on an ESTRO course)
Accommodation
ESTRO covers the costs for your accommodation (including breakfast and WIFI) in
the Ipanema Park
hotel
in a
single
room for
6 nights
*
in the period between 11 and 17 June 2016.
Extra costs at your personal charge.
Check-–‐in date
:
................. June 2016
Approx. check-–‐intime
: ................................
Check-–‐out date
: ................. June 2016
Number of nights
:
................................
*
Additional nights can be reserved by us, but are at your own expense. You will have to pay for these extra nights
upondeparture.
Turning point polling software
I will NOT make use of any polling software in my lectures
I will use turning point for (specify the lectures you will use it for and if you will use it during or at the
end of your lecture)