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BRICKLESS
CENTRE
8-9 September, 2015
Registration for meeting of the Danish Consortium for NMD and Brickless Centre
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The annual meeting of the Danish Consortium for NMD and Brickless Centre will be held at Musholm –
Ferie Sport Konference – for further information, please visit www.musholm.dk
Note that there is an early fee before 15 June and a late fee after 15 June.
Upon receipt of your registration form, you will receive an invoice by email.
Please fill in and print out form and send or email to:
RehabiliteringsCenter for Muskelsvind
Kongsvang Allé 23
DK - 8000 Aarhus C, Danmark
Contact person: Annette Mahoney, Tel.: +45 8948 2222, e-mail: anmo@rcfm.dk
Before 15 June
Danish Consortium for NMD
(7 September - 10.00 - 17.00)
⃝ DKK
After 15 June
600
⃝ DKK
800
⃝ DKK
⃝ DKK
650
800
Note: If you sign up for Brickless 8-9 September including accommodation, participation in the
Consortium meeting on 7 September is free of charge.
I would also like to participate in the reception for Birgit Steffensen
⃝
Accommodation and breakfast 7-8 September
In shared double room
In single room
⃝ DKK
⃝ DKK
Brickless Centre (8 September, 09.00 - 9 September, 12.00)
In shared double room
In single room
⃝ DKK 2,000
⃝ DKK 2,200
⃝ DKK 2,300
⃝ DKK 2,200
Brickless Centre (8-9 September without accommodation)
⃝ DKK
⃝ DKK 1,700
550
700
1,500
Brickless Centre (8 September without accommodation and dinner)
⃝ DKK 600
Total
⃝ DKK
800
DKK____________________
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BRICKLESS
CENTRE
8-9 September, 2015
Workshop session 8 September:
⃝ 1: Medical management
⃝ 2: Social management, education and job
⃝ 3: Physical assessment and rehabilitation
I would like to present a project on 9 September.
Project title:
________________________________________________________________________________________
________________________________________________________________________________________
Name
Profession
Place of work
Email
Invoice address
Organization/Company_________________________________________________________
Address______________________________________________________________________
City and zip code______________________________________________________________
Country______________________________________________________________________
Email________________________________________________________________________
EAN number
(Only in Denmark)
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