First Caspian Region Workshop important registration deadlines:
Early registration 15 august 2011
Late registration 15 september 2011 Please note that using this offline registration form is subject to an additional € 10 administration fee. online registration is available on www.eage.org. registration form
Please return this form by fax or post to the Europe Office or Russia & CIS Office (address details can be found on the next page)
E-mail EAGE will send confirmation of your registration to this e-mail address. Please make sure you enter a valid e-mail address. registration fees
All fees are in Euros (€) (incl. VAT where applicable). All members' rates are only applicable if the membership fee for 2011 has been paid before 15 March 2011. registered and paid 16/08/2011 - 15/08/2011 15/09/2011 Workshop short Course (eet 5)
EAGE members / EAGE student members € 75
Due to postal or bank delays, registration by post and/or bank transfer will not be accepted after 01 september 2011. Please note that the EAGE reserves the right to cancel the workshop and/or the short course due to low participation.
In that case, payment will be refunded in full. totaL registration fee Please calculate your total fee:Fee Workshop
1 To qualify for the reduced registration fee, a copy of your student identification card at a geoscience institute must be submitted together with this registration form.2 The non-member fee includes EAGE membership for (the remainder of) 2011. First Caspian Region Workshop methods of Payment
Please debit my credit card:
Credit card number (plus security code): (American Express 4 digits and Visa/MasterCard 3 digits)
Paid by bank transfer in the amount of Euros (€)
Made out to: EAGE Services bv, Bank: ABN-AMRO Bank, The Netherlands, account/iBan number: NL92ABNA0455199728 BiC/swift code: ABNANL2A
Paid by bank transfer in the amount of Roubles
Made out to: EAGE Geomodel. Our Moscow office will contact you regarding the (Roubles) payment details as soon as the
n.B. no registration forms will be handled unless accompanied by full payment.
I hereby certify that I have read and accept the conditions of registration and cancellation as stated on the EAGE website (www.eage.org). non-memBers
Please complete the details below for your EAGE membership.
I would like to become member of the following division(s):
eage membership includes a copy of first Break each month, free access to earthdoc (eage’s online publication database), access to Learning geoscience (eage's education website) and an online subscription to one additional journal.
Geophysical Prospecting online (6 x per year)
Near Surface Geophysics online (6 x per year)
Petroleum Geoscience online (4 x per year)
employer classification Job focus (max. 2 answers) interests (max. 2 answers) other society affiliations Please return the completed form to: eage russia & Cis office Build.1, korp. 6, 3rd floor Starokaluzhskoye shosse, 62 117630 Russia, Moscow Tel.: +7 495 6619285 E-mail: email@example.com eage europe office Registration Department Liability
EAGE cannot be held liable for non attendance due to visa issues or any other travel or legal obstructions. If an
event or part of an event is cancelled, EAGE shall not be responsible for airfare, hotel or other costs incurred
by the registrants. Speakers and program agenda are subject to change. EAGE shall not be liable for damages,
expenses, personal injury or loss except when caused by gross fault or negligence on the side of EAGE. EAGE’s
liability is expressly limited to the amount paid for this event by the participant to EAGE.
You have been booked to have a Combined DOBUTAMINE and SUPINE BIKE EXERCISE STRESS ECHO at Hearts West, Subiaco Purpose of the test Dobutamine stress echocardiography (DSE) is used to measure how your heart responds to stress, under medically supervised conditions. The test gives us very important information, and is usually performed for suspected coronary artery disease.
$25,000 ISTANBUL, TUR 31 Oct 2011 - 06 Nov 2011 Last Updated: 18 Oct 2011 Main Draw Date of Birth Ranking Spec'l Information Priority Main Draw Wild Cards Date of Birth 32 Qualifying Date of Birth Ranking Spec'l Information Priority Rank Date: 10 Oct 2011 All players who compete in ITF Pro Circuit tournaments must have a valid IPIN and sign-up to t