7th Internationl Symposium on Chelating Agents in Biomedicine, Toxicology and Therapeutics, July 8 - 11, 2004, Pilsen, Czech Republic
   TOURS FORM
 
First Name
Surname
Title
Mailing Address
Post Code
Town
Country
Phone
Fax
E-mail
Accompanying Person(s)
I WOULD LIKE TO RESERVE THE FOLLOWING TRANSFER/S:
Event Date Time Price No. of tickets
Transfer to Pilsen Thursday, July 8
19:00
18 EUR
Transfer to Prague Thursday, July 11
14:00
18 EUR

I RESERVE THE FOLLOWING TOUR/S:
Event Date Time Price No. of tickets
City Tour Prague Thursday, July 8
16:00
20 EUR
City Tour Prague Sunday, July 11
16:30
20 EUR

All tours will take place if attended by at least 15 persons.

Reservation will be guaranteed only after receipt of the payment for the chosen tour/s or transfer/s.

CANCELATION FEES:
Any cancellation must be notified in writing to the Symposium secretariat.
Cancellation without any charges is possible until June 15, 2004.
After this date 100 % cancellation fee will be charged.

In case of exchange rate changes by more that 5 % Conference Partners Prague has the right to modify prices.
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 Èeskoslovenská 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)