AO ASIF Course Registration Form

Hand Course and Principles Course
Davos, Switzerland
Saturday, December 1 - Thursday, December 6, 2001
(Travel dates: Thursday, November 29 and Friday, December 7)

Advanced, Experts Meet Experts, Maxillofacial, and Spine Courses
Davos, Switzerland
Sunday, December 9 - Friday, December 14, 2001
(Travel dates: Friday, December 7 and Saturday, December 15)

Registration is limited. Do not consider yourself registered in the course until official confirmation is received. Registration will not be accepted unless tuition fees are included with registration form.

(Please type or print clearly for official course listing and course certificates)

Name: __________________________________________________

Attending: ___ Resident: ___ PGY Year: ___

Degree(s): __________________________________________________

Social Security No.: __________________________________________________
(for documentation purposes only)

Citizen of (Country): __________________________________________________

Hospital Affiliation: __________________________________________________

Home Address:
City: __________________________________________________

State: __________________________________________________

Zip: __________________________________________________

Phone: (Office) ___________________________________

Home Phone: ___________________________________

Fax: ___________________________________

Email: __________________________________________________

Guest's Name: __________________________________________________

Have you attended an AO ASIF Basic (Principles) Course? Yes ___ No ___

Have you attended an AO ASIF Comprehensive Spine Course? Yes ___ No ___

Please enclose copy of certificate(s)

Spine Course applicants please respond:

Orthopaedic ___ Neurosurgeon ___

How many spine osteosynthesis have you performed? 0 ___ <60 ___ >60 ___

Are you an orthopaedic surgeon or neurosurgeon with a specialized spine practice? Yes ___ No ___

Maxillofacial Course applicants indicate surgical specialty:

Oral and Maxillofacial ___ Otolaryngology ___ Plastic ___ Other ___

Do you have any special needs? Yes ___ No ___

__________________________________________________

COURSE REQUESTED
(Please refer to Course Descriptions for detail.)

December 1-6
( ) Hand Course CHF
1900
( ) Principles (Orthopaedic)1500

December 9-14
( ) Advanced (Orthopaedic)CHF
1800
( ) Maxillofacial Course1900
( ) Spine Interactive I1900
( ) Spine Interactive II*1900
( ) Banquet ticket (per person)80
*Please refer to page 15; attach required documentation to registration form

( ) Experts Meet Experts
(Choose one per day)		 CHF
1500
MONDAY( ) Locking Compression or
( ) Computer Presentation
TUESDAY( ) Osteotomy I or
( ) ARI/ADI
WEDNESDAY( ) Osteotomy II or
( ) Proximal Humerus
THURSDAY ( ) Pelvis and Acetabulum or
( ) Wrist
FRIDAY ( ) Foot and Ankle or
( ) Navigation

For estimated US dollars, see Course Description

HOTEL ACCOMMODATIONS

Single Room: ___Double Room: ___
Arrival Date: ______________Departure Date: _______________

Reservation Remarks: ________________________________________________________________________

________________________________________________________________________

Category:Double Room
w/ bath breakfast		Single Room
w/ bath breakfast		 Double Room
w/ bath halfboard		Single room
w/ bath halfboard
A *****/****CHF 140CHF 160CHF 164CHF 184
B ****CHF 125CHF 145CHF 149CHF 169
C ***CHF 95/105CHF 115/125CHF 113/123 CHF 133/143
D ***/**CHF 90CHF 110CHF 108 CHF 128
E**(without bath)CHF 73CHF 86CHF 91CHF 104
Rooms without private bathroom - Approximately CHF 10 less (only a few rooms available)

All prices in Swiss Francs per person and per day.

As a guarantee for your hotel booking, we will need your credit card number, which will be passed to the hotel. No advanced payment needed; you will settle your bill at check out. In case of non-arrival the room may be charged to your credit card.

TUITION PAYMENT OPTIONS

Payment by Check
Bank: Credit Suisse, Davos-Platz
Acc. No. 518.000-41-9/Bank code: 4187

The registration is validated only when the tuition fees have been paid. Registrations will be accepted in chronological order. Early booking is advisable. Your registration will be confirmed after receipt of the registration form and the payment.

A check can be sent with the registration form. The name of the participant must be clearly indicated on the check.

Charge my credit card:

( ) Visa ( ) Mastercard ( ) American Express

Card Number________________________________

Expiration date_______________________________

Signature __________________________________
(all credit card orders must be signed)

Please return completed Course Registration Form and payment to:

AO Course Secretariat
Clavadelerstrasse
CH-7270 Davos-Platz
Switzerland
Phone: 41 81 414 27 20
Fax: 41 81 414 22 84
E-mail: courses@ao-asif.ch

During the courses:
Convention Center
CH-7270 Davos-Platz
Phone: 41 81 414 61 11
Fax: 41 81 414 64 26

The course Registration Deadline is August 31, 2001

AIR RESERVATION FORM

AIRFARE
Gateway CityPrice per person
Atlanta $693.36
Boston$625.86
Chicago (O'Hare)$691.36
Los Angeles $790.86
Miami$656.99
New York (JFK) $625.86
Newark$625.86
Washington, D.C. (Dulles)$674.86
Montreal$770.26

Passenger Facility charges may apply. Airfares are subject to change based on availability at time of booking and are not guaranteed until ticketed.

Airfares are non-refundable. The exceptions are: hospitalization of the passenger, death of the passenger or an immediate family member. Upon receipt of proper documentation, the airfare will be refunded less applicable penalty. Ask about children's rates.

If Swissair is offering lower airfares at the time of purchase, World Travel will offer passenger the lowest available fare.

Ground transportation

Upon arrival into Zurich, it will be necessary to take the train to Davos (travel time approx. 3 hours). Train tickets can be purchased through World Travel. Optional bus transportation from Davos to Zurich is also available at a nominal fee of $75.00 one way. Children under 12 are free.

Name: __________________________________________________________________

Address: ________________________________________________________________

Phone Number: ___________________________________________________________

Email Address: ___________________________________________________________

Special Requests: _________________________________________________________

________________________________________________________________________

Please add my Frequent Flyer account number to my air reservation:

Airline Name____________________Account Number_________________________

Please make checks payable, in U.S. funds, to:

World Travel Incorporated

Amount Enclosed:

$__________________________________

Charge my credit card:

( ) Visa ( ) Mastercard ( ) American Express

Card Number________________________________

Expiration date_______________________________

Signature __________________________________
(all credit card orders must be signed)

Please return completed Air Reservation Form with payment to:

World Travel Incorporated
Attn.: Group Department-Davos 2001
1724 West Schuylkill Road
Douglassville, PA 19518
Phone: (800) 867-2970
Fax: (610) 327-8874

List names of passengers (no nicknames), passport number, date of birth for yourself, spouse, guests, and children. Please fill in originating city, gateway city, departure date and return date.

Please type or print clearly.

1.
Name: _______________________________

Passport Number: _________________________

Birthdate:________________

Originating City: __________________ Gateway City: _____________________

Departure Date: __________________ Return Date: __________________

Seating Preference: ( ) Window ( ) Aisle

2.
Name: _______________________________

Passport Number: _________________________

Birthdate:________________

Originating City: __________________ Gateway City: _____________________

Departure Date: __________________ Return Date: __________________

Seating Preference: ( ) Window ( ) Aisle

3.
Name: _______________________________

Passport Number: _________________________

Birthdate:________________

Originating City: __________________ Gateway City: _____________________

Departure Date: __________________ Return Date: __________________

Seating Preference: ( ) Window ( ) Aisle

4.
Name: _______________________________

Passport Number: _________________________

Birthdate:________________

Originating City: __________________ Gateway City: _____________________

Departure Date: __________________ Return Date: __________________

Seating Preference: ( ) Window ( ) Aisle

5.
Name: _______________________________

Passport Number: _________________________

Birthdate:________________

Originating City: __________________ Gateway City: _____________________

Departure Date: __________________ Return Date: __________________

Seating Preference: ( ) Window ( ) Aisle

Davos Course Information