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Chelators 2004 - ACCOMMODATION FORM
7th Internationl Symposium on Chelating Agents in Biomedicine, Toxicology and Therapeutics, July 8 - 11, 2004, Pilsen, Czech Republic
   ACCOMMODATION FORM
 
First Name
Surname
Title
Mailing Address
Post Code
Town
Country
Phone
Fax
E-mail
Accompanying Person(s)
Arrival
Departure
Nights
I WOULD LIKE TO RESERVE THE FOLLOWING ACCOMMODATION:
HOTEL SINGLE ROOM DOUBLE ROOM No. of requested
SINGLE ROOMS
No. of requested
DOUBLE ROOMS
Panorama ****
54 EUR
85 EUR
Slovan ***
48 EUR
70 EUR
CD **+
39 EUR
58 EUR
Bolevecká kolej a)
20 EUR
20 EUR
Bolevecká kolej b)
– breakfast:   July 9
 July 10    July 11
23 EUR
26 EUR

Prices are per room ( except of a) and b) ) for one night incl. breakfast and VAT.
a) double room single use or a regular double room in one apartment without breakfast
b) double room single use or a regular double room in one apartment with breakfast at the Šafránek Building

Reservations will be guaranteed only after receipt of the first night deposit.
The balance of the hotel account has to be settled by June 15, 2004.
In case of exchange rate changes by more that 5 % Conference Partners Prague has the right to modify prices.

CANCELATION FEES:
Cancellation within 30 – 22 days prior to arrival: 50 % of booking value
Cancellation within 21 – 16 days prior to arrival: 70 % of booking value
Cancellation within 15 – 0 days prior to arrival: 100 % of booking value

TOTAL PAYMENT:
Automatic summarization of total payment:    EUR
I pay by bank transfer. Copy of the bank draft of amount of   EUR is send by mail or by fax to the Symposium Secretariat.
  Bank account No.: 176970780/0300 of the Conference Partners Prague
at the Československá obchodní banka, a.s., Anglická 20, 120 00 Prague 2, Czech Republic.
SWIFT CODE: CEKO-CZ-PP, IBAN CODE: CZ6403000000000176970780
 
I authorize the Conference Partners Prague to charge the total payment of   EUR to my credit card:
 
VISA     Eurocard/Mastercard
Card holder’s name (as appears on card)
Card No.
Expiry date
CVC code*
(* CVC code are the last three figures which are on the top of the signature strip on the back side of the card)