Important Information
This course will be limited to 60 participants. Applications will be accepted on a first-paid, first-served basis. You will receive acceptance and confirmation by e-mail.
Upon receipt of a written cancellation, a refund of fees minus a 50EUR cancellation fee 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. All payment information submitted will be supplied to the hotel, which will charge you directly. The ERS will only act as a customer service intermediary between the hotels and the participants. The ERS will not bear any liability or financial responsibility towards the hotels or the participants.

First Name *

Last Name *

Gender Male Female

ERS Membership Number

Date of Birth *

Address *

Postal Code *

City *

Country *

Phone Number *

Fax Number

Delegate Email Address *

Agency Email Address
For any agency applying on behalf of a delegate

Current Position Trainee or fellow Prof or Dr in University Dr in general hospital or affiliate Dr in private practice hospital Respiratory Nurse/Therapist Pharmacologist Industrial Representative Adult Care Paediatric Care

Degree

Specialty

Do you wish to apply for a bursary? (ERS Members only)

 Yes

 No

Information
ERS bursaries are for applicants coming from countries with with economies in transition. Should you wish to apply for a bursary, please note that you must be a full ERS member. Your curriculum vitae, as well as a one-page personal statement explaining how you would apply the knowledge gained from this course are also compulsory. Files can be sent by email to school@ersnet.org or by fax 0041 21 213 01 00

The deadline for applications for bursaries is 30 March 2012
Applicants will be notified of selection results by 16 April 2012

CV Submission
No larger than 5Mb

Personal Statement Submission
No larger than 5Mb

Fees * ERS Member - 600 Euro Junior - 500 Euro Non-ERS Member - 700 Euro Industry - 1,100 Euro

Categories
ERS Member – a person who is an ERS Member at the time of registration
Non ERS Member – a person without an ERS-Membership at the time of registration
Junior – all health care specialists under 35-year-old at the time of registration including Non-ERS members
Industry – a representative of any medical business company at the time of registration

Special discount
Please note that an early bird discount of €50 will be given to registrations made before 30 March 2012.

Credit Card Visa card Euro / Master card

Credit Card Number

CVV2 Code (Security Code)
The CVV2 code is the 3 last digits at the back of your card.

Expiry Date

Information
To book your room, please contact the respective hotel by fax or email indicating that you are a participant on the ERS course “Pulmonary Hypertension and Pulmonary Vascular Disease”

Hotel Ibis Lausanne Centre**
Single Room: CHF149.00 /night
Breakfast: CHF 15 /person/night
Tourism tax: CHF 2.50/night

Reference number for reservation: 115425
Contact Details: Phone: +41 21 340 07 07
Email : h6772@accor.com
Website : http://www.ibishotel.com/gb/hotel-6772-ibis-lausanne-centre/index.shtml


Hotel Elite***
Single Room in single use: CHF 145/night
Single Room in double use: CHF 170/night
Double Room in double use: CHF 190/night
These prices include VAT and breakfast
Tourism tax: CHF 2.50/night

Reference number for the reservation: ERS Course
Contact Details: Phone: +41 21 320 2361
Email: info@elite-lausanne.ch
Website http://www.elite-lausanne.ch/

Hotel Union***
Single Room: CHF 105/night
Double Room: CHF 135/night
These prices include VAT and breakfast
Tourism tax CHF 2.50/night

Reference for the reservation: ERS
Contact Details:
Phone: +41 21 654 41 00
Email: info@hotel-union.ch
Website: http://www.hotel-union.ch/

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