Prague International Health Summit 2020

13. - 14. 5. 2020 Praha

Registration form
 

Registration

Participant
Title
Last name*
First name*
Degree
Gender*
Order code (if you received it)
Opening Ceremony
Transfer to Opening Ceremony
Don´t ask printed materials

Affiliation

Name of institution*
Position
Street*
ZIP code*
City*
Country*
Phone
Fax
E-mail*
Id-number
VAT-number
Id-VAT-number (SK)

Invoice Address (if different)

Name of institution
Department
Street
ZIP code
City
Country
Phone
Fax
E-mail
Id-number
VAT-number
Id-VAT-number (SK)

Accommodation

  Hotel Arrival Departure Room Beds
     dd.mm.yyyy  dd.mm.yyyy    
  Without accommodation      
  Hotel International     single  (price 128 EUR/person)
double  (price 64 EUR/person)
 
  I want to share room with  

Payment method

Payment   Note
bank transfer
 
on-line card
 
 

Bank transfer information:


Account number: 1379507504/0600
Variable symbol: 205
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



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