42nd CONGRESS & CHAMPIONSHIP
OF THE WORLD MEDICAL TENNIS SOCIETY
Cervia - Milano Marittima 22nd – 29th September 2012
official website: www.amti.it/wmts
REGISTRATION FORM -aNAME:
NAME SPOUSE/SIGNIFICANT OTHER:
ADDRESS:
COUNTRY
ZIP/POSTAL CODE
MEDICAL SPECIALIZATION/DEGREE:
SPOUSE’S IF MD
PHONE:
E-MAIL:
FAX:
@
YOUR TENNIS PROFICIENCY:
EXCELLENT
‰
GOOD
‰
FAIR
‰
SPOUSE’S TENNIS PROFICIENCY:
EXCELLENT
‰
GOOD
‰
FAIR
‰
REGISTRATION IS RESTRICTED TO:
1. Doctors in good standing in the Medical Tennis Association of the country in wich they reside/practice.
2. Spouses or significant others of physicians as defined in 1.
Each official WMTS delegate will be responsible for the qualifications of registrants from their country. Partecipation in the
tennis tournament is restricted to physicians and spouse or significant others.
CATEGORY
DISCOUNT
BEFORE 30TH JUNE
AFTER
30TH JUNE
PHYSICIAN ATTENDING
350,00 €
440,00 €
YOUNG ATTENDING
born in 1972 or later
290,00 €
330,00 €
SPOUSE PLAYER
290,00 €
330,00 €
NON PLAYER AND ADULT
GUEST
200,00 €
290,00 €
EACH CHILD 12-18 years
100,00 €
150,00 €
CHILD < 12 years
free
free
NUMBER OF
PERSONS
TOTAL IN
REGISTRATION FEE INCLUDES: Tennis Tournament, Welcome Reception, Dancing night - local folk dance exhibition with
food, sweets and wine. Awards Ceremony. Farewell Dinner. Bus transportation. Scientific Sessions and WMTS contribution fee.
ON SITE REGISTRATION AND PAYMENT WILL NOT BE POSSIBLE
Method of Payment: Please pay the registration fee by BANK TRANSFER to:
AMTI ASD - BCC Banca di Credito Cooperativo di Roma - Filiale n. 103 “Centocelle”
IBAN: IT53 T083 2703 2370 0000 0003 394 - BIC: ROMAITRRXXX
Please send this registration form, carefully completed by post, fax or e-mail
enclosing your payment receipt to the following address, before August 31th 2012
POST: Bartolo Bresciano - via Raimondo Galvagno 8, 12030 Marene (CN) - ITALY
FAX: (0039) 0172 744924 - E-MAIL: [email protected]
Please to pay the registration fee by CREDIT CARD visit Our WMTS Website
instructions in the Registration Section at this link : www.amti.it/index-1.html .
To visit directly this page You can click on this text.
and follow the
Signature
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42"d CONGRESS & CHAMPIONSHIP
OF THE WORLD MEDICAL TENNIS SOCIETY
Cervia- Milano Marittima 22nd - 29th September 2012
official website: www.amti.it/wmts
REGISTRATION FORM -bPLEASE READ THE FOLLOWING INSTRU CTIONS CAREFULLY
GENERAL CONDITIONS AND CANCELLATION POLICY.
Kindly transmit the REGISTRATJON FORM by no Jater than the 30st June 20 12 for an early registration discount.
After receiving your tournament REGISTRATlON FEE, the following cancellation charges will apply:
50 euro.
- from June 30 through July 3 1, 2012
LOOeuro
- fromJuly 3 L throughAugust3 1,2012
- after August 3 1, 20 12
no refu nd
By affixing my signature to this registration form, l give my permission for public photos offunctions which might include me
or any members of my party to be posted on the WMTS website with my name thereto attached, and permission for results of
competition and scientific meeting pa1tecipation to appropiately include my name.
By affixing my signature l declare that r hold or have held a Medicai License to practice medicine.
By signing this registration, I acknowledge l and any member of my registering party agree we are responsible for our ow11
health and partecipate at our own risk.
IMPORTANT DATES
By 3oth Junc 2012:
Most favourable deadline for registration (submission of the registration form, payment of the registration fee, accommodation
resevation , accommodation payment)
By 3oth June:
Deadline for the submission of the abst:racts and of the applications for the poster secti.on . The application for lecture or poster
presentations, includif!g abstracts,must be submitted exclusiveJy on line; that is trOUJ~h the fonn f\J?plication for Active Pa•tecjpation which may be found on the official website.
By 31st August 2012:
Fin al deadl in e for on-line registration an d preregistration (submission of the registration form, payment of the registration fee).
31st AUGUST 2012IS T HE FINAL DEADLINE POR ALL PAYMENTS.
ORGANIZERS
President
Past President
Emeritus President
Vincenzo SCIACCA
Antonio CELLINI
Bartolo BRESCIANO
SCJENTlFIC COMMITTEE
President
Vice President
Secretary
Vincenzo SCIACCA
Claudio MAPFJ
Marco SALIN
TOURNAMENTTEAM
Luisella BRESCIANO
Loredana TARABORELLI
Giambattista BRIZZT
Paolo FRUGONl -a m ti secretary
Claud io MAFFl - amti treasurer
Luca SARTORI - press attachè
TECNICA L ASSISTANCES
International Judge & Umpire Tournament
Roberto NATALI - amti umpire advisor
Franco REALI - amti tournament director
WEBMASTER
Created by AXENTWEB
Andrea Sciacca-
@tiscal