Important Information
This course is limited to 80 participants. Applications will be accepted on a “first-paid, first-served” basis. You will receive acceptance and confirmation by email.
Upon receipt of a written cancellation, a refund of fees will be applied up to 4 weeks before the course. After this date no refund will be made for cancellations.
Please note: the ERS will not directly debit any deposit or penalty payments from your credit card for your hotel booking. The ERS will only act as a customer service intermediary between the hotels and the participants. The ERS will not bear any liability, nor financial responsibility towards the hotels, nor the participants.

First Name *

Last Name *

Gender * Male Female

ERS Membership Number

Date of Birth *

Address *

Postal Code *

City *

Country *

Phone Number *

Fax Number

Email Address *

Current Position Trainee or fellow Prof or Dr in University Dr in general hospital or affiliate Dr in private practice

Degree *

Specialty
Bursary Application

Do you wish to apply for a Bursary?

 Yes

 No

Information
The ERS grants a limited number of bursaries for each course.
Should you wish to apply for a bursary, please note that you MUST upload your curriculum vitae and a one-page personal statement explaining how you will apply the knowledge gained from this course.

The dealine for bursary applications is October 10, 2011
Applicants will be notified of selection results by November 12, 2011

CV Submission

Personal Statement Submission

Fees * Non-ERS Members €700 ERS Members €600 Junior €500 Industry € 1100

Special Discount
Please note that an early bird discount of €50 will be given to registrations made before 12 October 2011

Credit Card Visa Euro/MasterCard

Credit Card NUmber

CVV2 Code (Security Code)
The CVV2 Code is the 3 digits on the back of your credit card

Expiry Date

Information
The European Respiratory Society (ERS) has negotiated a special price for rooms at the Ibis Hotel*.
Please note that the room charges are not included in the registration fee. The ERS cannot guarantee the rate nor the availability
of the hotel rooms for the course, therefore please ensure you make your hotel reservation as early as possible to guarantee your booking.

Please refer to the “ERS, Pulmonary Rehabilitation course” to reserve a room at a special rate.

If you would like to reserve a room at the Ibis Hotel, please contact the hotel directly at: H1457-re@accor.com

Phone: +32 (0)16 29 31 11
Fax: +32 (0) 16 23 87 92

Hotel Ibis Leuven Centrum

Please refer to the “European Respiratory Society 162 032” to reserve a room at a special rate.
Price per person per night (including breakfast):

Single room on Thursday 12.01.2012: €108.00

Single room on Friday 13.01.2012: €85.00

Hotel Cancellation Policy
All cancellations must be made in writing.
In case of a no show, the whole amount of your stay will be charged.



Should you wish to stay in cheaper accommodation, the Mille Colonnes Hotel does offer student type accommodation. ERS will not take responsibility for your booking. If you would like to avail of this, please contact the Hotel directly at info@hotelmillecolonnes.be

Phone: +32 (0) 16 22 86 21

Fax: +32 (0) 16 22 04 34


Price list per person and per night (including breakfast):

Single room: from €45.00 to €60.00
Double room: from €70.00 to €80.00
Please refer to the “ERS, Pulmonary Rehabilitation course” to reserve a room at a special rate. All participants will get a €5.00 discount per night.

Hotel Cancellation Policy
All cancellations must be made in writing.
In case of a no show, the whole amount of your stay will be charged.

Comments

Note
As a participant of an ERS school course, you will receive a 1 year electronic access to the society's website containing all electronic publications and educational resources.
For those participants under 35 whol will attend this course, you will automatically be offered a Silver-Under 35 membership free of charge.
We hope that you have the opportunity to learn more about ERS and ERS activitied.

Should you have any questions do not hesitate to contact the school team school@ersnet.org