Pakistani-Descent Physicians Society (PPS) APPNA Illinois Chapter CME International Meeting


Budapest (Hungary) – Vienna (Austria) – Bratislava (Slovakia) – Prague (Czech Republic)

Saturday August 02 – Sunday august 10, 2014

See attachments for details and programs:

Europe Trip Detailed Itinerary Program

Meeting Chair: Dr Irfan Mirza
CoChair: Dr Mansoor Alam

Registration Form

You can either fill the form below and submit or Print and fax it to us at (317-536-3366)

To book your flights, please call EZ Travel at 713-278-8685 and talk to Asif or Basit.

Personal Information

Person 1. (Name as it appears on your passport, spell as they are on passport)
First Name
Middle Initial
Last Name
Nationality/country of passport
Passport Number
Expiration date on passport
Date of Birth on Passport
Departure City/airport
Person 2. (Name as it appears on your passport, spell as they are on passport)
First Name
Middle Initial
Last Name
Nationality/country of passport
Passport Number
Expiration date on passport
Date of Birth on Passport
Departure City/airport
Person 3. (Name as it appears on your passport, spell as they are on passport)
First Name
Middle Initial
Last Name
Nationality/country of passport
Passport Number
Expiration date on passport
Date of Birth on Passport
Departure City/airport
Person 4. (Name as it appears on your passport, spell as they are on passport)
First Name
Middle Initial
Last Name
Nationality/country of passport
Passport Number
Expiration date on passport
Date of Birth on Passport
Departure City/airport
Person 5. (Name as it appears on your passport, spell as they are on passport)
First Name
Middle Initial
Last Name
Nationality/country of passport
Passport Number
Expiration date on passport
Date of Birth on Passport
Departure City/airport

Information for communication:

Street Address
City
State
Zip
Home Phone
Cell Phone
Fax
Email Address

Hotel information:

Number of rooms required
(each room must have 2-pp, unless single supplement)
Type of rooms (circle one): Room #1: 1-bed 2-beds Room #2: 1-bed 2-beds (Room type is not guaranteed)
Special Needs (if any)
Visa: Visa is NOT required for US passport holders.
Green Card Holders: Green card holders will be issued a letter for their visa contact Tipu / Mona.
Registration deadlines: April 30, 2014 ** (Limited numbers on this trip)

** Registration may be stopped prior, if maximum capacity of group is filled
** All registrations will be entertained on first come – first registered and paid basis
** Group fare for airlines are limited and will be based on first come first registered basis

** The prices shown include flights from Chicago in Economy
** Price does not include domestic flights in USA and Fuel Surcharge and Taxes on International flights can change.

Payment Information:

Cost per person for first & second person in same room (double occupancy) $3770 with airfare from Chicago, cost with out airfare age 12 and above $2350 =$

Child Ages 2-11 sharing room with two adults $2700, cost with out airfare upto age 11 $1300=$

Child under Age of 2 FREE FREE
Single Supplement (Add) $775 =$
CME Fees: (All Physicians must register for CME) $150

Grand Total: $
Note: If you like to make your own flight arrangements, Please deduct/pay less $1420 per person (You will be responsible for your airport/hotel/airport transfers) Plan to arrive in Budapest on August 3rd by 6:00 PM and depart from Prague on August 10th, 2014.

(Full payment is due at the time of registration, which is fully refunded, less credit card service fees, by April 20th, 2014

For your safety we require all applicants paying by CREDIT CARD to submit payment information via Phone to TIPU AHMED/ MONA (317-222-1370) or Fax (317-536-3366) or email (mona@meetingsnmore.us).

If paying with check
Checks payable to ; Advance Travel

Check Number and Check Amount (check must be received within 7-days or April 30th, whichever comes first)

If paying with credit card
Credit Card, Exp. Date, Name on Credit Card and Amount. 4% Merchant service charge will be added to credit card transactions that is non-refundable.

 

Cancellation:
** Full payment is refundable, if cancelled by April 20, 2014.
** A 50% refunds will be issued if cancelled after April 20, 2014 and before May 25, 2014.
** No Refunds will be given if cancelled after May 25, 2014.
** ALL CANCELLATIONS MUST BE SUBMITTED IN WRITING BY EMAIL OR FAX TO mona@meetingsnmore.us fax # 317-536-3366 PPS or its tour operator does not carry any trip cancellation insurance, it is your responsibility to buy any insurance, information on insurance will be sent to all registrants.

Instructions:
**This PPS Conference Registration Form can be used to register a group of up to 5 attendees. This form contains common Information pertaining to all registrants including the Primary Registrant. You must provide details of each member of your group.

** Incomplete Applications may cause unnecessary delays in making your reservations.

** Please note that space is limited. PPS reserves the right to limit or refuse attendance at any time for any reason.

** Submitting this application does not guarantee you or your group to attend.

** Please send copy of passports of all registrants along with your application by fax or mail.

** If you have any questions, please call at 317-222-1370

To contact Chairman of meeting Dr. Irfan Mirza, write at iamirza@aol.com or CoChair Dr. Mansoor Alam at mansoor_ayesha@yahoo.com.

Disclaimer:
** The responsibility of PPS, Advance Travel LLC and its Tour Operator in coordinating tour, hotel, travel or visa arrangements is limited. PPS, Advance Travel LLC, and its tour operator assumes no liability whatsoever for injury, damage, loss, baggage loss, accident, delay or irregularity which may be occasioned either by reason of defect, through the acts or defaults of any company or person engaged in the management for travel or tour, or from any cause beyond PPS’s control.

Itinerary:
** Deviations to planned itinerary may occur due to weather, traffic or any other conditions beyond our control such as strike, acts of God, war, fire, acts of Government, riots, etc. We will do our best to insure that all the tours and visits are as mentioned in the itinerary that will be sent to all registrants.

Insurance:
** Attendees are required to have their own insurances for cancellation, emergency, accident, health or any travel related to this trip. Send your Registrations to:

By Mail: Complete and mail enclosed registration form along with a check payable to Advance Travel and mail:
Advance Travel
722 Willow Pointe South Drive
Plainfield, IN 46168

By Fax: Complete and fax this registration form along with your credit card information at 317-536-3366

Your Name
Email Address
Phone
Date
I acknowledge that the above information is correct.