REGISTRATION FORM

Surname First Name(s) Title Institution/Affiliation Mailing Address Post Code Town Country Phone Fax E-mail Accompanying person(s) FOR EUROPEAN UNION ONLY! Participants are obliged to indicate VAT number if the payment is made by a company or institution. VAT number:

REGISTRATION FEE

REGISTRATION FEE - SELECT PROPER OPTION(S): Delegates 590 EUR  EUR Students 350 EUR *  EUR * Please note a copy of your valid student's ID if student's fee applies should be sent to cfrac2013@conferencepartners.cz. CANCELLATION CONDITIONS AND REFUNDS: Any cancellation must be notified in writing to the conference secretariat. The registration fee will be refunded after the deduction of 40% if participation is cancelled prior to 30 April 2013. No refund will be possible after this date but complete documentation will be sent to the address of the delegate. The already paid registration can be transferred (without additional charges) to another participant from the same university, research institute or company. I WILL ATTEND THE FOLLOWING SOCIAL EVENTS: Welcome drink (June 4, 2013) incl. in reg. fee Welcome reception & Concert (June 5, 2013) incl. in reg. fee Conference dinner (June 6, 2013) incl. in reg. fee FOR ACCOMPANYING PERSON I WISH TO BUY THE TICKET FOR THE FOLLOWING SOCIAL EVENTS:   Price: No. of tickets: Welcome reception & Concert (June 5, 2013) 40 EUR Conference dinner (June 6, 2013) 50 EUR

TOTAL PAYMENT

I enclose a copy of the bank transfer* in the amount of    EUR.   Bank account No.: 176 970 780 / 0300 of the Conference Partners Prague Ltd., Československa obchodni banka, a. s., Anglická 20, 120 00 Prague 2, Czech Republic. IBAN: CZ64 0300 0000 0001 7697 0780, SWIFT/BIC code: CEKOCZPP * Please note a copy of the bank transfer should be sent to cfrac2013@conferencepartners.cz.   I authorize the Conference Partners Prague Ltd. to charge my credit card with the total payment of    EUR.     VISA     Eurocard/MasterCard Card holder’s name (as appears on card) Card No. Expiry date