Prague International Health Summit

21. - 22. 5. 2026

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

Registration

Participant
Order code (if you received it)
Academic Title
First Name*
Last Name*
Degree
E-mail*
*) mandatory data will be used for further communication / conference documents access

Social evening

Description   Price/ 
Person  		   Participation/  
  No. of Persons  
I wish to participate in the social event on Thursday 21st May
tick if applicable 		     

Contact Address

Company*
Position
Street*
ZIP code*
City*
Country*
Phone
Fax
E-mail*
Company ID-number
VAT-number
ID-VAT-number (SK only)

Invoice Address (If different)

Company
Position
Street
ZIP code
City
Country
Phone
Fax
E-mail
Company ID-number
VAT-number
ID-VAT-number (SK only)

Accommodation

  Hotel Arrival Departure Room Number of beds
     dd.mm.yyyy  dd.mm.yyyy    
  Without accommodation      
  Hotel Pyramida     single  (price 147 EUR/person/night)
double  (price 82 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: 236
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