University of North Carolina
Department of Orthodontics
Dr. H. Garland Hershey, Dr. David J. Hall,
Dr. Dan Grauer
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Registration Fees
Registration
350 (Before January 30 2009)
450 (After January 31 2009)
Student
275
If you have selected the student fee you must submit a University certification by fax to +34 93 410 19 05 or by e-mail to
bcnortho@viajeseci.es
March 2009
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Hotel
Hotel choice
Room
Double
Single
Hilton Barcelona
250.00
210.00
Melia Barcelona
203.50
182.00
NH Constanza
199.50
181.00
AC Irla
155.50
155.50
Husa Illa
195.00
179.00
Date in
March
2009
Date out
March
2009
Please check this box if you dont need hotel reservation in Barcelona
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By checking this box I accept the my Credit Card will be charged the following amount:
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Payment Data
International transfers:
Entity :
Banco Bilbao Vizcaya Argentaria
Account :
ES97 0182 3999 3702 0066 4662
BIC :
BBVAESMMXXX
Spanish transfers:
Entity :
Santander Central Hispano
Account :
0049 1500 03 2810355229
Amount:
€
Register on-line or fax the application form with credit card information or bank transfer receipt to: +34.93.410.19.05
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