REGISTRATION FORM HOTEL BOOKING FORM by pengxuebo

VIEWS: 16 PAGES: 2

									PAYMENT                                                                                    POST CONFERENCE TOUR
                                                                                                                                                                    Czech Technical University in Prague
Please sum the amounts due for your reservations:                                          The Organising Committee of the                                     ,
Registration fee                                              ___________        EUR       is happy to offer you
                                                                                                                                                                           Czech Chemical Society
Accompanying person(s) registration fee                       ___________        EUR       a post-conference week-end tour to Prague, the capital of                 I. M. Marci Spectroscopic Society
Accommodation (total per stay)                                ___________        EUR
Transfer to/from Mariánské Lázně                              ___________        EUR
                                                                                           Czech Republic, and one of the world's most popular tourist                 Czech Radioecological Society
                                                                                           destinations of the recent years.
Post Conference Tour to Prague                                ___________        EUR
                                                                                           Prague is a city of thousand years history, abounding in beauty and
TOTAL AMOUNT DUE                                              ___________ EUR              truly unique gems of art. Like Rome, Prague was originally built on
Please tick your preferred payment method:                                                 seven hills, too. Lot of its charm was acquired from the stream
                                                                                           waters of Vltava (Moldau) river meandering through the centre of the
G By credit card (minimum one night deposit must be paid):                                 city.

   I hereby authorise you to charge my credit card with the amount                         The atmosphere and beauty of Prague is not given merely through
   indicated below.                                                                        the unique conglomeration of architecture from all the past periods
                                                                                           but also through the pulsating life which brings forwards the heritage
   Amount: ______________________________________ EUR
                                                                                           of past ages.
   G American Express                 G Master Card*               G Visa Card**
   Card No.: __________________________________________                                    Tour Programme
   Expiry Date: ________________________________________
                                                                                           The preliminary programme of the Tour is as follows:
   *Card Validation Code/ **Card Validation Value ____________
   (the last 3 small numbers near your signature on the reverse side of the credit card)   Friday, 19 April 2002:      17:00-17:30 Arrival to the hotel in Prague
                                                                                                                       19:00-22:00 Boat trip with dinner
   Name of the Cardholder:               ____________________________
                                                                                           Saturday, 20 April 2002: 09:45-14:00 Sightseeing tour of Prague
   Address of the Cardholder: ____________________________
                                                                                                                           (English-speaking guide, lunch)
                                         ____________________________                                               Evening* Concert or ballet performance
   Date: _______________
   Cardholder´s Signature:               ____________________________                      Sunday, 21 April 2002:      No programme - leisure time

G Direct Bank Transfer (minimum 100 EUR must be sent) to:                                  * Saturday evening concert or ballet performance is optional, its
                                                                                             price is not included in the Tour price.
   Komerční banka, Dejvická 52, 160 59 Praha 6, Czech Republic
                                                                                           The Saturday guided sightseeing tour will include all the major sights
        Account Name:       ČVUT v Praze - SÚZ
                                                                                           of Prague – Old Town Square with Astronomical Clock, Charles
        Account Number: 27-4082120257/0100
                                                                                           Bridge, Lesser Town, Prague Castle (visit to St. Vitus's Cathedral).
        Details of payment: "Variable symbol: 7057"
                            Surname of the participant(s)                                  To be able to easily move around the city, all participants will be
   N.B. All direct bank transfer charges must be covered by the                            provided with a three-days public transportation ticket, city and                 14 - 19 April 2002
        participant(s). Please, forward a copy of your bank                                public transportation maps, and other information materials.
        transfer order to the Conference Secretariat.
                                                                                                                                                                             Mariánské Lázně
                                                                                                                                                                              Czech Republic
G On-site payment                                                                          Accommodation & Prices
   N.B. On-site payment is acceptable for the registration fees, only.
        Minimum one night hotel deposit must be paid in advance.                           All the participants will be accommodated in a *** hotel. The price of
                                                                                           the accommodation, as well as of breakfast, will be included in the
We regret that no personal or company cheques can be accepted.                             Tour price. Please, indicate your preference for the location of the
                                                                                           hotel in the attached Registration Form.
CERTIFICATE OF STUDENTSHIP                                                                 Central location hotel: EUR 160/130 per person in single/double
As a Department Head, I the undersigned,                                                                           room, respectively, extra night EUR 80/50
Name (in block letters): __________________________________                                Other location hotel:    EUR 120/100 per person in single/double           REGISTRATION FORM
certify that the registrant is still a full-time student                                                            room, respectively, extra night EUR 40/30
Signature: _____________________________________________                                   N. B. The Tour is subject to minimum of 15 participants.
                                                                                                                                                                     HOTEL BOOKING FORM
REGISTRATION                                                               ACCOMMODATION                                                               Prices per room and night, incl. breakfast, city charge and VAT:




                                                                                                                                                                                                                                  Final Registration Form
                                                                                                                                                                                                                                                                                        Name ______________________________________________________________________________________________________________

                                                                                                                                                                                                                                                                                                                                                                                                                                             Organisation ________________________________________________________________________________________________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Mailing Address ______________________________________________________________________________________________________

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   ___________________________________________________________________________________________________________________



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Hotel name _____________________________________________________________ Single/Double room _________________________




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Signature ________________________________________________________________ Date ____________________________________
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Telephone ___________________________________ Fax ___________________________________ E-mail ______________________



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Arrival ______________________ Departure ______________________ No. of nights ____________ No. of persons _______________




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  , Ms. K. Rosíková, Department of Nuclear Chemistry, Faculty of Nuclear Sciences
The attached registration and hotel booking form is a self-                The following hotels are available for the Conference participants:                       Hotel                  Single room       Double room




                                                                                                                                                                                                                                                                                                                                                                                                              Title (Dr., Mr., Mrs., etc.)




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Number of persons:
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Number of persons:
billing order form that should be returned to the Conference                                                                                            Villa Butterfly ****                  65 EUR            90 EUR
                                                                           VILLA BUTTERFLY




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    and Physical Engineering, Czech Technical University in Prague, Břehová 7, 115 19 Prague 1, Czech Republic, Fax: (+420 2) 232 0861.
Secretariat with your payment of the fees.
                                                                           Address: Hlavní třída 655, Mariánské Lázně. Category: ****                   Hvězda & Skalník ****                 55 EUR            90 EUR
Conference registration fee will cover all the conference
                                                                           Walking distance to Casino: 10 min.                                          Flora ***                             50 EUR            70 EUR




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Country
organisational costs, including a Booklet of Abstracts, Conference
Proceedings, coffee-break refreshments and several social activities       Garage, rooms with toilet, tub, satellite TV, telephone, mini-bar.           Kriváň ***                            40 EUR            70 EUR
(e. g. welcoming reception, conference dinner, excursion, concert).        Fitness centre, sauna, lounges for discussions and social meetings           Svoboda ***                           33 EUR            53 EUR
In addition to the social activities, the accompanying persons fee will    available. Two restaurants and lobby bar.                                               *                          16 EUR            24 EUR
include a sightseeing tour in Mariánské Lázně and two trips to the
                                                                                                                                                        Universita Karlova **                 33 EUR            40 EUR
country.                                                                   HVĚZDA & SKALNÍK




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             other location hotel
Before the registration form can be processed, the method of                                                                                            Zlatý zámek **                        20 EUR            35 EUR
                                                                           Address: Goethovo náměstí 7, Mariánské Lázně, Category: ****
payment for the total amount reserved must be indicated thereon            Walking distance to Casino: 5 min.
and the payment received in the due time. Confirmation showing the         Parking, rooms with toilet, bathroom with shower or tub, satellite TV,      NOTA BENE




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Postal Code or ZIP
confirmed reservations will constitute an acceptance of the                telephone, mini-bar, in-room safe. Physicians consultation offices,         All rooms will be reserved on the first come first served basis. After
registration.                                                              therapy centre, hair salon, cosmetic salon, pedicure centre. Three          31 January 2002, the Conference Secretariat is allowed to change




                                                                                                                                                                                                                                                                                                                                                                                                              Middle Initial

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Department




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Yes
Please, make sure that all the data you give in the Registration Form      dining rooms, café with music and dancing, lobby bar.                       your demand depending on the available rooms left. Location of
are accurate and follow the format required (order of names,                                                                                           hotels in Mariánské Lázně with respect to Casino, as the Conference




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          G
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          G
affiliation, mailing address). These data will appear on your name tag     FLORA                                                                       centre, can be seen on the plan overleaf. Payment of minimum one
and in all the official conference publications.                           Address: Nehrova 128, Mariánské Lázně. Category:***                         night deposit is required at the time of booking. Immediately after




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             central location hotel
                                                                           Walking distance to Casino: 10 min.                                         receiving your Registration Form and the payment, you will be sent
REGISTRATION FEES                                                          Parking (five cars only or Central City Garages), rooms with toilets,       a voucher for the services on the basis of which you will be
                                                                           shower, satellite TV, telephone. Two restaurants, coffee bar.               accommodated.
                  Early Registration    Late Registration     On-site
                 (before 31.1.2002)    (before 15.3.2002)   Registration




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         State or Province (if applicable)
                                                                                                                                                       CANCELLATIONS




                                                                                                                                                                                                                                                                                                                                                                                                              First (Given) Name
                                                                           KRIVÁŇ
 Participant         500 EUR              550 EUR           600 EUR
                                                                           Address: Masarykova 17, Mariánské Lázně. Category: ***                      Participants who might wish to cancel their reservations must inform
 Student             300 EUR              330 EUR           360 EUR




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             No
                                                                           Walking distance to Casino: 5 min. Parking, rooms with toilets,             the Organising Committee in writing or by fax.
 Accompanying        160 EUR              160 EUR           160 EUR        shower, satellite TV, telephone, mini bar. Restaurant, small                Cancellations made after 1 March 2002 are subject to cancellation fee




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          G
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          G
 person                                                                    relaxation centre – whirlpool, water massage boxes, massages,               of 25% of the registration fees plus 10 EUR of each the
                                                                           fitness centre.




                                                                                                                                                                                                                                  14 - 19 April 2002, Mariánské Lázně, Czech Republic
                                                                                                                                                       accommodation and/or Post Conference Tour (if applicable).




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       I wish to take the Conference Bus to and from Mariánské Lázně:
TRAVEL




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        No
                                                                                                                                                       For cancellations made after 1 April 2002, no refund of the registration
The Organising Committee will provide a Conference Bus for those           SVOBODA                                                                     fees or of the price of the Post Conference Tour (if applicable) will be




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 G
wishing to use it for transportation from Prague to Mariánské Lázně        Address: Chopinova 393, Mariánské Lázně, Category: *** and *                done. The payment for accommodation will be refunded except for the
and back. The bus will depart from Prague centre (via the airport) on      Walking distance to Casino: 10 min.                                         one night deposit.




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Company, University, etc.
Sunday, 14 April afternoon and it will leave Mariánské Lázně on            The Svoboda Spa Hotel consists of a complex of a main building and




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        I wish to book the Post-Conference trip to Prague:
                                                                                                                                                       Substitution of delegates within the same company, after a reservation
Friday, 19 April afternoon. The price of one return ticket is EUR 20.      two adjacent accessory buildings, Margareta and Palladio.                   fee has been paid, is acceptable at any time and no extra fee is




                                                                                                                                                                                                                                                                                                                                                                                                              Last (Family) Name
Please, indicate your intention to use the bus in the registration form    Parking without attendance or Central City Garages,                         payable.
and add the respective amount to your fees.                                category *** – rooms with toilet, tub or shower, satellite TV, telephone,
                                                                           mini-refrigerator,
CONFERENCE SECRETARIAT                                                     category * – toilets and showers on the floor.                              LIABILITY / INSURANCE




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Street
                                                                           Dining room and café (main building), spa therapy centre (Palladio).        All tickets and reservations made by the Organising Committee in
The conference secretariat address, where all inquiries on the




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Please mail or fax this form to:
                                                                                                                                                       respect of the services provided by the hotels and the companies
technical topics, exhibiting, submittal of abstracts, general topics,
programme or accommodation should be addressed is:
                                                                           UNIVERSITA KARLOVA                                                          providing road transport are made by the Organising Committee as
                                                                                                                                                       agent, and not as principal. The Organising Committee accepts no




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         City
                                                                           Address: Hlavní třída 390, Mariánské Lázně. category: **
                                                                                                                                                       responsibility for death, injury, loss, accident, or delay arising in
                                                                           Walking distance to Casino: 10 min.
     Ms. Kateřina Rosíková                                                                                                                             connection with such services. The organisers make no warranty or
                                                                           Rooms with toilet, bathroom with either shower or tub, telephone, TV.
     Department of Nuclear Chemistry                                                                                                                   representation in connection therewith. All such services are provided
                                                                           No parking, Central City Garages next to the hotel.




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Please mark:
     Faculty of Nuclear Sciences and Physical Engineering                                                                                              subject to local laws. Delegates are therefore strongly advised to take
     Czech Technical University in Prague                                                                                                              out adequate personal insurance.
     Břehová 7, 115 19 Prague 1, Czech Republic                            ZLATÝ ZÁMEK                                                                 The Organising Committee reserves the right to amend the
     Fax: (+420 2) 232 0861                                                Address: Klíčová 4, Mariánské Lázně. Category: **                           conference arrangements if necessary. If it is necessary to cancel any
     E-mail: radchem@br.fjfi.cvut.cz                                       Walking distance to Casino: 5 min. Rooms with toilets, bathroom             of the conference arrangements, an appropriate refund will be made
     http://www.fjfi.cvut.cz/radchem                                       with a shower, telephone. Parking available.                                and thereafter the Organising Committee's liability will cease.

								
To top