German Medical Association

German Medical Association
of
Ozone Application in Prevention and Therapy
Member of the “European Cooperation of Medical Ozone Societies”
Augusta-Clinic Bad Kreuznach
October, 22 – 23, 2004
Ozone in Rheumatology and
Myofacial Pain Syndroms
APPLICATION FORM
Please fill in and send to :
Sekretariat “Aerztliche Gesellschaft für
Ozontherapie in Praevention und Therapie“
Nordring 8
D-76473 Iffezheim
Tel.: 0049-30 46 25
Fax.: 0049-7229-304630
* I shall attend the Ozone Seminar “Ozone in Rheumatology and Myofacial
Pain Syndroms” October, 22 – 23, 2004 in
Bad Kreuznach, Augusta-Clinic
Registration Fee
* Member:
€ 100.00
* Non member : € 140.00
* Accompanying person : € 30,00
Forms of payment:
I have transferred the amount of € __________ to Sparkasse Krefeld, bank
access no 320 500 00; account no 61 00 74 23.
SWIFT: SPKR DE 33 IBAN: DE70 3205 0000 0061 0074 23
Name: ________________________________________________
Address:______________________________________________
Tel/Fax:_______________________________________________
E-mail:________________________________________________