Online-Registration

Online-Registration
24th International Congress of Individual Psychology

Vilnius/Lithuania, July 31 - August 03, 2008

Online-Registration

Please, submit this form for each participant separately!

Last Name :

First Name:

Titel:

Profession:

Street, No.:

ZIP-Code, City:

Country:

Phone:

Fax:

E-Mail:

Registration Fee Before May 15, 2008 After May 15, 2008 Amount Due (EUR)

Participant/Lecturer EUR 250 EUR 300

Full time students from universities and Adlerian Training Institutes (please send proof of status) and participants from Eastern Europe EUR 60 EUR 75

Accompanying person (with same address, not valid for lecturers) EUR 60 EUR 75

Workshops (on July 31, 2008 - just one workshop possible)

No 1: McGill/de Vries (2 hours)
EUR 20

No 2: Kern/Kern (4 hours) EUR 40

No 3: Günther (1.5 hours) EUR 15

No 4: Mansager/Trail (2.5 hours) EUR 25

No 5: Team Istituto Alfred Adler (about 4 hours) EUR 40

Social Programme: Fee per person Number of persons: = Amount due (EUR)

Welcome Reception (July 31, 2008)
EUR 10

Congress Banquet (August 02, 2008) EUR 30

Total Amount EUR:

Payments (in EURO only) will be done

to bank account of Institute of Individual Psychology, Lithuania
SEB Bank AB, Vilnius
SWIFT CBVILT2X
IBAN LT48 7044 0600 0578 4605

by credit card (please check as follows):
Important! The credit card information will be sent via email without encryption.

Visa Card no.:

Mastercard Expiration date (MM/YY): /

Card holders name :

Adress of Congress Office:
Institute of Individual Psychology
Pamenkalnio street 19-8
LT - 01114 Vilnius
Fax: +370 / 52 47 17 51
E-Mail: vilnius_congress@yahoo.com

Online-Registration
Online-Registration
Please, fill in all bold printed fields!
(Also the type of payment.)";} if ($bOK_participant == 0) {echo "
Please, fill in a type of registration.
";} echo "
Please, use the back function of the browser window to correct your input data."; } else { // inputs were ok: // echo "welcome ...

"; $test = "Last name: "; $test .= $_POST[lastname] . "
"; $test .= "First name: "; $test .= $_POST[firstname] . "
"; $test .= "Titel: "; $test .= $_POST[titel] . "
"; $test .= "Profession: "; $test .= $_POST[profession] . "
"; $test .= "Street: "; $test .= $_POST[street] . "
"; $test .= "ZIP-Code: "; $test .= $_POST[zipcode] . "
"; $test .= "City: "; $test .= $_POST[city] . "
"; $test .= "Country: "; $test .= $_POST[country] . "
"; $test .= "Phone: "; $test .= $_POST[phone] . "
"; $test .= "Fax: "; $test .= $_POST[Fax] . "
"; $test .= "eMail: "; $test .= $_POST[EMail] . "
"; // *************************************************************************** // Registration Fee......... // *************************************************************************** if ($_POST[participant] != ""){ $test .= "Fee participant/lecturer: "; $test .= $_POST[participant] . "
"; } if ($_POST[student] != ""){ $test .= "Fee student: "; $test .= $_POST[student] . "
"; } if ($_POST[accomp_person] != ""){ $test .= "Fee accompanying person: "; $test .= $_POST[accomp_person] . "
"; } // *************************************************************************** // Workshops ......... // *************************************************************************** if ($_POST[no1] != ""){ $test .= "No 1 - McGill/de Vries: "; $test .= $_POST[no1] . "
"; } if ($_POST[no2] != ""){ $test .= "No 2 - Kern/Kern: "; $test .= $_POST[no2] . "
"; } if ($_POST[no3] != ""){ $test .= "No 3 - Günther: "; $test .= $_POST[no3] . "
"; } if ($_POST[no4] != ""){ $test .= "No 4 - Mansager/Trail: "; $test .= $_POST[no4] . "
"; } if ($_POST[no5] != ""){ $test .= "No 5 - Team Istituto Alfred Adler: "; $test .= $_POST[no5] . "
"; } // *************************************************************************** // Social Programme......... // *************************************************************************** if ($_POST[amount_welcome] != ""){ $test .= "Number of persons - welcome: "; $test .= $_POST[amount_welcome] . "
"; $test .= "Amount due: "; $test .= $_POST[eur_welcome] . "
"; } if ($_POST[amount_banquet] != ""){ $test .= "Number of persons - banquet: "; $test .= $_POST[amount_banquet] . "
"; $test .= "Amount due: "; $test .= $_POST[eur_banquet] . "
"; } $test .= "Total Amount EUR: "; $test .= $_POST[total_amount] . "
"; // *************************************************************************** // Payment.......... // *************************************************************************** $test .= "Payment: "; if ($_POST[radio_zahlung] == "bank_account") { $test .= "To bank account
"; } if ($_POST[radio_zahlung] == "credit_card") { $test .= "By credit card
"; $test .= "credit card: "; if ($_POST[radio_Kredit] == "Visa") { $test .= "Visa
"; } if ($_POST[radio_Kredit] == "Mastercard") { $test .= "Mastercard
"; } $test .= "Cad no.: "; $test .= $_POST[Kartennummer] . "
"; $test .= "Card holders name: "; $test .= $_POST[Karteninhaber] . "
"; $test .= "Expiration date MM/YY: "; $test .= $_POST[Kredit_Monat] . "/" . $_POST[Kredit_Jahr] . "
"; } //echo $test; $headers = "MIME-Version: 1.0\r\n"; $headers .= "Content-type: text/html; charset=iso-8859-1\r\n"; $headers .= "From: International Congress\r\n"; mail("vilnius_congress@yahoo.com", "Online-Registration ... International Congress", $test, "", $headers); //monika@nousmaa.de echo "

Thank you for your registration!
" ; } ?>

Copyright © 2005 International Association of Individual Psychology