Angiological days 2004

REGISTRATION AND ACCOMMODATION FORM

Items with color background are obligatory!

Registration:

Mr. Mrs. Ms.

First name:

Surname:

Title:

Institute/Department:

Address – street:

Postal code/ZIP:

City:

Country:

Phone:

Fax:

E-mail:

Payment:

	Early Paid before January 16, 2004	Standard Paid after January 16, 2004	On Site
Regular Fee	35 EUR	40 EUR	45 EUR
Nurses, Students, Seniors	15 EUR	20 EUR	25 EUR
Lunch Thursday, 19th February	4 EUR	4 EUR	5 EUR
Lunch Friday, 20th February	4 EUR	4 EUR	5 EUR
Lunch Saturday, 21st February	4 EUR	4 EUR	5 EUR
Get-together party	4 EUR	4 EUR	5 EUR
Accommodation	see below of this form
Total Due:

Registration fee includes: registration, participation in sessions and exhibition, conference materials, coffee breaks Total Due: EUR

Reservation of Accommodation:

Your chosen accommodation cannot be guaranteed without receiving the registration form by January 16, 2004.
Hotel assignment will be made on the first-come, first-serve basis.
Therefore it is important to make reservation of accommodation as soon as possible.
Arrival date: Departure date:
Nights total:

	Category	Single Room	Double Room
1.	Olympik ****	55 EUR	65 EUR
2.	Olympik Tristar ***	50 EUR	60 EUR
3.	Čechie ***	45 EUR	55 EUR
4.	Novoměstský Hotel ***	50 EUR	60 EUR
5.	Masarykova kolej ***	30 EUR	35 EUR
6.	Aura ***	20 EUR	25 EUR
7.	Kolej Petrská **	15 EUR	35 EUR
8.	Kolej Větrník *	10 EUR	20 EUR
9.	Kolej Bubenečská *	10 EUR	15 EUR

Accompanying person:

Accommodation includes bed, breakfast (except student hostels Větrník a Bubenečská kolej), city charges and VAT.

Note please that the reservation of accommodation cannot be made without the deposit covering 50% of the amount due or 100% if your reservation is one night only. The hotel voucher will be mailed to you upon receipt of payment.

Payment:

Registrační poplatek a poplatky za další objednané služby uhradím:

	By credit card. I hereby authorise you to charge my credit card with the amount indicated below: American Express Euro/Master Card* Visa Card** Amount EUR * CVC/Card Validation Code: ** CVV/Card Validation Value: = the last 3 small digits printed near your signature on the reverse side of the credit card
	Credit Card No.:
	Name and address of the cardholder:
	Expiry Date:
	Direct Bank Transfer to: Bank: Komerční banka, Dejvická 52, 160 59 Praha 6, Czech Republic Account name: ČVUT v Praze - SÚZ, Vaníčkova 7, 160 17 Praha 6 - Strahov Account Number: 27-4082120257/0100 Details of payment: Variable Symbol 7076 + participant's surname and name N.B. Please note that all direct bank transfer charges must be covered by the participant. Please forward a copy of your bank transfer order to the address of our Congress Department.
	On site.
	Exception of payment.

Cancellation:

When unable to attend the conference, we will charge your total amount due with:

	Before January 16, 2004	Between January 17 and February 2, 2004	After February 6, 2004
Registration Fee	20 %	100 %	100%
Accommodation	5 EUR	50% of one night deposit	one night deposit

Angiological days 2004

REGISTRATION AND ACCOMMODATION FORM

Items with color background are obligatory!

Registration:

Reservation of Accommodation:

Payment:

Cancellation:

Programme

Announcement

Forms

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