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Title: |
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Firstname:
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Surname:
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Email:
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Institution:
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Address:
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City:
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Country:
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Zip code:
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| Sex: |
male
female
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Accompanying Person
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Yes (Reduced conference fee - banquet only: 800 CZK)
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Please check days of your stay in hotels below as well as in the meal section.
otherwise your total cost will not be calculated correctly!
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Accommodation: |
Type of accomodation:
(payment included in conference)
- hotel Monty
Single Room (1800 CZK/night)
Double Room (1250 CZK/night & person)
- hotel Zlatý Zámek
Single Room (850 CZK/night)
Double Room (600 CZK/night & person)
Preffered room-mate(s):
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Please check reqired nights? |
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Meals:
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Please fill in the ordering form bellow.
Prices of meals: lunch 160 CZK and dinner 200 CZK. |
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Type of presentation
(preferable):
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Registration deadline is June 30.
Poster
Oral
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Title of presentation:
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Abstract:
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| Conference fee: 6500 CZK (approx. 270 Euro) |
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On Wednesday there will be organized a short sightseeing tour with official guide (free of charge).During this tour several spa springs will be visited. |
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| Conference account: |
Account owner:
Address:
Account number:
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Jaroslav Burda
Sidlistni 245/18g
165 00 Prague 6
Czech Republic
2200101091 / 2010
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Bank Name:
Bank Address:
IBAN:
BIC/SWIFT: |
Fio banka, a.s.
V Celnici 1028/10
117 21 Praha 1,
Czech Republic
SK13 8330 0000 0022 0010 1091
FIOZ SKBA XXX |
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Attention please!
Your application will be valid after your payment to the conference account.
Since the amount of participants is limited, please, do not pospone the bank transfer. |
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