Manual for ESTRO Teachers

FACULTYREPLY FORM

ESTRO course on Evidence Based Radiation Oncology , Porto, Portugal, 12 – 17 June 2016

Please return the completed form to makkers@estro.org by 1 April 2016

Please complete your details/requirements:

Personal information (as printed on your passport)

First name: ................................................... Dietary requirements: ..................................

Family name: ............................................................ Physical requirements: ................................................

Travel & insurance Travel costs are covered by ESTRO at economy rates.

 I will arrange for my own travel to Porto and back. Only book your travel after having received written approval by the ESTRO office. Costs can be claimed back based on actual invoices /original receipts and through the reimbursement form that you will receive onsite in Porto.  Please book my travel I will travel by: □ Train / □ Plane Departure: from (city/country) ....................................................... and day ............ June 2016 Return: to (city/country) ....................................................... and day ............ June 2016  I have my own medical, travel and personal insurance  I would like to take out the ESTRO travel insurance since this is not offered by my regular employer (unlimited medical and repatriation expenses for the time spent on an ESTRO course) Accommodation ESTRO covers the costs for your accommodation (including breakfast and WIFI) in the Ipanema Park hotel in a single room for 6 nights * in the period between 11 and 17 June 2016.

Extra costs at your personal charge.

Check-–‐in date :

................. June 2016

Approx. check-–‐intime : ................................

Check-–‐out date : ................. June 2016

Number of nights :

................................

* Additional nights can be reserved by us, but are at your own expense. You will have to pay for these extra nights upondeparture.

Turning point polling software  I will NOT make use of any polling software in my lectures  I will use turning point for (specify the lectures you will use it for and if you will use it during or at the end of your lecture)

□ from ESTRO computer □ from ESTRO computer □ from ESTRO computer □ from ESTRO computer □ from ESTRO computer □ from ESTRO computer

□ from my computer □ from my computer □ from my computer □ from my computer □ from my computer □ from my computer

Lecture 1 ............................................................... Lecture 2 ............................................................... Lecture 3 ............................................................... Lecture 4 ............................................................... Lecture 5 ............................................................... Lecture 6 ...............................................................