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8th Meeting of the EBMT Paediatric Diseases WP, 3rd Meeting of the EBMT Paediatric Nurses including Inborn errors WP educational day

8th Meeting of the EBMT Paediatric Diseases WP, 3rd Meeting of the EBMT Paediatric Nurses including  Inborn errors WP educational day

Registration form


All fields marked with * must be filled in.

Participant
Title:
First name/s*:
Surname / Family name*:
Institute / company:
Student / school:
Profession:
Street*:
City*:
ZIP*:
Country*:
ID No.:
VAT ID No:
Phone*:
Fax:
E-mail*:
Accompanying person
Title:
Name:
Surname:
Registration fees *
Cathegory By 31st March 2012 By 30th April 2012 By 31st May 2012
Physician EBMT-member € 260 € 275 € 290
Physician non EBMT - member € 275 € 290 € 305
Nurse EBMT - member € 150 € 160 € 170
Nurse non EBMT - member € 175 € 185 € 195
Accompanying person € 90 € 90 € 90
One Day Registration - Physician € 125 € 140 € 155
One Day Registration - Nurses € 75 € 85 € 100
Exhibitor € 275 € 290 € 305
 
Accommodation reservation
TOP HOTEL Praha ****
Type of roomPrice (per person and night)No. of persons
Double Standard € 40
Single Standard € 53

note

Date of arrival Date of departure

Social programme
Date Price No. of persons
Welcome Party, Břevnov Benedictine Monastery, Prague 7th June 2012 € 0
Gala Dinner, Municipal House, Prague 8th June 2012 € 0
Related services
Price No. of persons
Transfer Ruzyně Airport - Top Hotel Prague by car € 40/car (1 - 3 persons)
Transfer Top Hotel Prague - Ruzyně Airport by car € 40/car (1 - 3 persons)
Transfer - Ruzyně Airport - Top Hotel Prague by minibus € 18/person (4 - 7 persons)
Transfer Top Hotel Prague - Ruzyně Airport by minibus € 18/person (4 - 7 persons)

For transfer arrangements, kindly fill in the Arrival - Departure Schedule and inform Congress Prague in case of any changes or cancellations.

Arriving
:
:
:
:
:
:
Departing
:
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Payment conditions

All prices given are in EUR (€). Kindly pay the respective amount in accordance with the Payment Order which will be issued and sent to you upon the delivery of your registration and hotel booking form. The payment is regulated by the general conditions and deadlines stated below. In case of bank transfer please send by post to the address of Congress Prague or to the fax number +420 241 445 806 a copy of the remittance receipt for the payment with your name and address indicated or else, please use the number of the respective Payment Order as the variable symbol for easier payment identification.
All payments must be net of all charges; all bank charges applied during the payment of the registration fee, reserved accommodation, or other services reserved through this form are to be paid by the payer.

In case of credit card payment, the bank Komerční banka charges an extra fee amounting to 3% of the total amount.

No cheques are accepted.

Payment by credit card*
Card type*
No of CC*
Expiration date of CC*
CVV/CVC code*
Holder's name*

CVV/CVC code is the 3 or 4 digit number located on the back of the VISA/MC card.

Payment by credit card / printed CC authorisation form * Form
Wire transfer *

Bank transfer
BankKB, a.s., Prague 10, expo Zahradní Město, Jabloňová 8/2992, Czech Rep.
Account No.:51-3712960257/0100 (EUR)
IBANCZ9801000000513712960257
Account owner: Congress Prague
Payment identificationvariable symbol - number of the relevant Payment Order

Declaration

By submitting this form I express my acknowledgement and accept the conditions and rules applied for registration, participation, hotel accommodation, payments, and also the general conditions and cancellation conditions set for the 8th Meeting of the EBMT Paediatric Diseases Working Party and 3rd Meeting of the EBMT Paediatric Nurses. I also authorise Congress Prague as the professional meeting organizer to use the data indicated in this form for further electronic processing for the purposes of the meeting.

Upon submitting the form successfully, you will be notified through an automatically generated e-mail sent to your e-mail address. In case no such confirmation is delivered, please contact directly the event organizer (office@congressprague.cz).

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Congress Prague
Tel.:+420 241 445 759
Fax.:+420 241 445 806
office@congressprague.cz