Prague International Health Summit

Prague, 25. - 26. 4. 2024

Registration form
 
*) Mandatory information
Do not use an automatic translator, the translated form cannot be submitted.

Registration

Participant
Title
Last name*
First name*
Degree
E-mail*
Gender*
Order code (if you received it)
I will participate in the evening gathering on the first day of the conference (please, check the box, if yes)
*) mandatory data will be used for further communication / conference documents access

Affiliations

Institution*
Department
Street*
ZIP code*
City*
Country*
Phone
E-mail*
ID-number
VAT-number
ID-VAT-number (SK only)

Invoice Address (if different)

Institution
Department
Street
ZIP code
City
Country
Phone
E-mail
ID-number
VAT-number
ID-VAT-number (SK only)
if different

Accommodation

  Hotel Arrival Departure Room Beds
     dd.mm.yyyy  dd.mm.yyyy    
  Without accommodation      
  Hotel Pyramida     single  (price 127 EUR/person/night)
double  (price 70 EUR/person/night)
  
  I want to share a room with  

Payment method

Payment
bank transfer
on-line card
 

Bank transfer information:


Account number: 1379507504/0600
Variable symbol: 222
Specific symbol: Your registration number
IBAN: CZ34 0600 0000 0013 7950 7504
BIC/SWIFT: AGBACZPP

For EUR payment use bank account: 115-1571780287 / 0100
IBAN: CZ44 0100 0001 1515 7178 0287
BIC: KOMBCZPP
Bank address: Komerèní banka, a. s.
Vrážská 1165
153 00 Praha 5



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