REGISTRATION FORM

Prague, September 10 - 15, 2010

 

Registration

Type
Title
Lastname*
Firstname*
Degree
Note

Accompanying persons

Name 1
Name 2
Name 3
Name 4
Name 5
Name 6

Institute (employer)

Name of institute*
Department
Street*
ZIP code*
City*
Country*
Phone
Fax
E-mail*
Id-number
VAT-number

Invoice Address (if different )

Name of institute
Department
Street
ZIP code
City
Country
Phone
Fax
E-mail
Id-number
VAT-number

Accomodation

  Hotel Arrival Departure Room Beds
     dd.mm.yyyy  dd.mm.yyyy    
  Without accommodation      
  Hotel Diplomat ****     Single  (price 105.00 EUR/person)
Double  (price 58.00 EUR/person)
  
  I want to share room with  
  Hotel Denisa****
(FULLY BOOKED)		     Single  (price 95.00 EUR/person)
Double  (price 55.00 EUR/person)
  
  I want to share room with  
  Masarykova kolej***
(FULLY BOOKED)		     Single  (price 50.00 EUR/person)
Double  (price 36.00 EUR/person)
  
  I want to share room with  
  Hotel Krystal***     Single  (price 30.00 EUR/person)
Double  (price 25.00 EUR/person)
  
  I want to share room with  

Post Conference Events

Description Price/
Person		  No. of
Persons
Farewell Dinner 9/14  49.00 EUR   
Prague Castle 9/11  45.00 EUR   
Old Town 9/12  48.00 EUR   
Carlsbad 13/9  90.00 EUR   
Konopiste Chateau 9/14  75.00 EUR   
Hluboka Castle 9/15  110.00 EUR   

Payment method

Payment   Note
payment by bank transfer
  All bank charges have to be paid by participants.
payment by credit card
  Please download the authorization form here and send it by fax +420 257 910 341
 

Payment information:

Account number: 1379507504/0600
Variable symbol: 140
Specific symbol: Your registration number
IBAN: CZ34 0600 0000 0013 7950 7504
BIC/SWIFT: AGBACZPP

If any technical problem occurs during registration, please, send a mesage to grygar@econtrol.cz
Should you want to make any change in registration, please, contact info@agenturacontour.cz