How To Use This Form:

• This Form is for one participant only.
• Feel free to photocopy this form for additional participants.
• Type in the form, on screen response, (fill out the blanks) and enter (X) in applicable boxes.
• Press TAB to move from one field to another.
• If you make a mistake, erase/delete and retype correct information.
• When finished print the completed Form, only one page (Banner will not print with Form).

Registration Fees: Registration Fees Include:

Active Participant: Early Registration (Before August 1st = $255) Late Registration (After August 1st = $305)

Access To Scientific Sessions Opening Ceremony Shuttle Service: Hotel - Congress Venue- Hotel Coffee Breaks Lunches Congress bag Gala Dinner

Payment:
Can be made by bank transfer to the following (Registration by credit cards are not accepted):

CONGRESS ORGANIZERS TRUST AND TRADERS TRADING AND SERVICES Ashrafieh St. Georges Hospital St. Bassil Bldg. Beirut, Lebanon Tel/Fax: (961 1) 445 421, 565 871 Cell: (961 3) 882 301

BYBLOS BANK GETAWI P.A.N.S III CONGRESS SWIFT: BYBA LB BX A/C no: 11-02-252-123064-0-8

Prof. Antoine Nachanakian Cleveland Clinic, Affiliate Physician (USA) Head Division of Neurosurgery St. Georges Hospital P.O. Box 166378 Beirut, Lebanon Tel: (961 1) 560 052 Fax: (961 1) 582 560