REGISTRATION FORM, ACCOMMODATION FORM Sympozium CEUS 2010

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Title:
Surname*:
First name*:
Organization*:
Department*:
Street*:
City*:
Zip code*:
Country*:
Telephone*:
Fax:
Email*:
Registration fees*:Early registration (by February 28, 2010) - 55 €
Late (March 1, 2010 - March 31, 2010) - 65 €
On-site (after April 15, 2010) - 75 €
Accommodation
Hotel Reservation*:Hotel Diplomat - Single room (110 €)
Hotel Diplomat - Double room (120 € Kč)
Hotel DAP - Single room (50 €)
Hotel DAP - Double room (85 € Kč)
without accommodation
Special requirements:
Arrival Date*:
Departure Date*:
I want to share the room with:
Verification*:
Captcha
 * Marked fields are mandatory.