CONGRESS, CONFERENCE AND INCENTIVE ORGANIZER

Title:
First name/s*:
Surname / Family name*:
Institute / company:
Student / school:
Profession:
Street*:
City*:
ZIP*:
Country*:	-- Choose your contry ----- Algeria Argentina Armenia Australia Austria Azerbaijan Bahrain Balears Islands Belarus Belgium Bosna and Herzegovina Brazil Bulgaria Cameroon Canada Chile China Congo Croatia Česká republika Denmark Egypt Estonia Finland France Georgia Germany Ghana Greece Guinea Hungary Iceland India Indonesia Iran Ireland Island Israel Italy Japan Jordan Kazakhstan Kirgyzstan Kongo Latvia Lebanon Libya Lithuania Luxembourg Macedonia Malaysia Malta Mexico Moldova Morocco New Zealand Nigeria Norway Pakistan Peru Philippines Poland Portugal Romania Russia Saudi Arabia Scotland Serbia Singapore Slovenia Slovenská republika South Africa South Korea Spain Sudan Sweden Switzerland Taiwan Tajikistan Thailand The Netherlands Tunisia Turkey Uganda Ukraine United Arab Emirates United Kingdom USA Uzbekistan Venezuela Vietnam Yugoslavia
ID No.:
VAT ID No:
Phone*:
Fax:
E-mail*:

Category	Before 31.05.2011	Before 30.06.2011	After 30.06.2011
Physician attending	€ 420	€ 470	€ 520
Young physician (born 1972 or later)	€ 375	€ 425	€ 475
Spouse player	€ 320	€ 370	€ 420
Non-player or adult guest	€ 250	€ 280	€ 300
Child aged 12-18 years	€ 120	€ 130	€ 140
Child under 12 years of age	€ 0	€ 0	€ 0

 

Grandhotel Pupp Comfort ****
Type of room	Price (per person and night)		No. of persons
Single Standard	€ 130
Double Single Use	€ 148
Double Standard	€ 80
Apartman Suite Double	€ 97.5
Apartman Suite Single	€ 195
Grandhotel Pupp *****
Type of room	Price (per person and night)		No. of persons
Double Single Use	€ 180
Double de luxe	€ 95
Apartman Suite Double-Junior Suite	€ 113
Apartman Suite Single - Junior Suite	€ 226
Hotel Diplomat ****
Type of room	Price (per person and night)		No. of persons
Double Superior	€ 70
Single Superior	€ 120
Hotel Gejzír
Type of room	Price (per person and night)		No. of persons
Triple Standard	€ 25

note

Date of arrival Date of departure

	Date	Price	No. of persons
Opening Ceremony and Reception	Saturday, 20th August 2011	€ 0
The National Evening	Tuesday, 23rd August 2011	€ 0
Presidents’ Meeting & Dinner	Wednesday, 24th August 2011	€ 0
The Award Ceremony	Friday, 26th August 2011	€ 0
Farewell Dinner	Friday, 26th August 2011	€ 0

	Price	No. of persons	Date
Carlsbad Becher Liqueur Distillery	€ 10
Moser Glass Museum	€ 15
Underground of the Thermal Spring Colonnade	€ 8
Crypt of the St. Máří Magdaléna`s Church	€ 8
Pilsen Guided City Sightseeing with Pilsner Historical Underground Tour	€ 12
Pilsen Guided City Sightseeing with Pilsner Urquell Brewery Tour	€ 12
The Premonstratensian Monastery in Teplá and Mariánské lázně	€ 32
The Town and The Castle Loket	€ 24
Český Krumlov – The UNESCO World Heritage (tour from Karlovy Vary)	€ 80
The Castle Bečov with St. Maur Shrine and Mariánské lázně	€ 29
Spa of Jáchymov	€ 24
Grand City Tour of Prague	€ 33
Jewish Prague	€ 43
Walk through the Old Town and Charles Bridge	€ 20
Short City Tour of Prague	€ 16
Prague Medieval Evening with the Dinner	€ 60
Night Prague from Bus and Boat (Buffet Dinner)	€ 55
Prague Night Cruise with the Dinner	€ 44
Český Krumlov – The UNESCO World Heritage (tour from Prague)	€ 80
Karlštejn Castle	€ 44
Kutná Hora – The UNESCO World Heritage	€ 48

	Price	No. of persons
Transfer Airport - Diplomat Hotel Prague	€ 33
Transfer Diplomat Hotel Prague - Airport	€ 33
Transfer by Car: Prague - Karlovy Vary (3 persons max)	€ 165
Transfer by Microbus: Karlovy Vary - Prague (8 persons max)	€ 220
Transfer by Car: Karlovy Vary - Prague (3 persons max)	€ 165
Transfer by Microbus: Prague - Karlovy Vary (8 persons max)	€ 220

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

Arriving

Arriving at:
Arrival date:
Arrival time:
Flight (train) number:
Coming from:
Transport to hotel:

Departing

Departing from:
Departure date:
Departure time:
Flight number:
Pick-up from hotel:
Destination:

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*	-- Choose a credit card type --Visa MasterCard
	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
Bank	KB, a.s., Prague 10, expo Zahradní Město, Jabloňová 8/2992, Czech Rep.
Account No.:	51-3712960257/0100 (EUR)
IBAN	CZ9801000000513712960257
Account owner:	Congress Prague
Payment identification	variable 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 41st Congress and Championship of the World Medical Tennis Society. 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.