REGISTRATION FORM NORDIC ENVIRONMENTAL CHEMISTRY CONFERENCE NECC 2010 Kindly return registration to: yngvar.thomassen@stami.no as an attachment or mail/fax to: Yngvar Thomassen National Institute of Occupational Health P.O. Box 8149 Dep., N-0033 Oslo, Norway Fax: +47 23 19 52 06 Surname: First name: Organization/company: Address: Telephone / Telefax: E-mail:
Accompanying person(s):
REGISTRATION FEE: (Price per person) Active participant Registered student Accompanying person
Before October 30, 2009 NOK 2500 NOK 1500 NOK 500
After October 30, 2009 NOK 3000 NOK 2000 NOK 1000
TOTAL NOK NOK NOK
TOTAL NOK:
Payment
Payment should be made either by bank transfer or by credit card. Bank transfer: Payment in Norwegian Krone (NOK) to: National Institute of Occupational Health NECC 2010/Project: 1118 P.O.Box 8149 DEP, N-0033 Oslo, Norway Using the following bank of beneficiary: DNB NOR, P.O. Box 1171 Sentrum, NO-0107 Oslo, Norway Bank account no: 7694.05.02027 Swift code: DNBANOKK IBAN: NO8476940502027 Please state your name and affiliation on the bank transfer form.
CREDIT CARD PAYMENT FORM NORDIC ENVIRONMENTAL CHEMSITRY CONFERENCE 2010 (NECC) Surname: First name: Organisation/company: Address: Telephone: Telefax: E-mail:
Amount of Payment (NOK): (With reference to submitted registration form) Name of Cardholder (typed):
Signature:
Expiry Date: Card Number: Visa :
Mastercard/Eurocard : American Express Diners Other (specify) : : :
Hotel accommodation
Hotel rooms and guesthouse rooms with special discount agreement have been reserved at Radisson Hotel Longyearbyen and Spitsbergen Guesthouse (simple standard). The cost includes breakfast. Accommodation is not included in the conference fee. Please note: we recommend that you book your flight ticket before you send in the registration and hotel reservation form, as March is a very popular month to visit Svalbard and flights might be fully booked at an early stage. Airplane tickets can be booked at: www.sas.no Radisson Hotel is located close to the UNIS conference venue (2 minutes walking distance). Spitsbergen Guesthouse is located approx. 3 kilometers from UNIS (approx. 20-30 minutes walking). Discounted room reservation can only be done through the NECC 2010 secretariat. Please indicate below if you need a hotel room or a guesthouse room (simple standard).
The room will be charged on your credit card upon check-in at the hotel/guesthouse.
Set X for room selection
Accommodation Room type Radisson Hotel Radisson Hotel * Spitsbergen Guesthouse single room double room* single room
Room price pr. night
TOTAL (3 nights)
NOK 1840 NOK 2 140* NOK 765
NOK 5520 NOK 6420* NOK 2295
* If you want a double room, please write the name of the other room guest:
Longer stay? If you are interested in a longer stay in Longyearbyen, there is a possibility to extend the Radisson Hotel accommodation reservation until March 8th. If you are interested in this, please indicate below the dates you want accommodation: Dates of Radisson Hotel accommodation:
Kindly e-mail to: Yngvar Thomassen: yngvar.thomassen@stami.no as an attachment Or mail or telefax to Yngvar Thomassen National Institute of Occupational Health P.O. Box 8149 Dep., N-0033 Oslo, Norway Fax: +47 23 19 52 06