3rd WORKSHOP ON ICHNOTAXONOMY
Prague, Jevíčko, September 4 – 9, 2006
   REGISTRATION FORM

First Name

Surname

Title
Institution
Mailing Address
Post Code
Town
Country
Phone
Fax
E-mail

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 - select proper option(s):
 
Payment (EUR)
Early registration (before May 31, 2006)
350 EUR per person in double room (*)
400 EUR per person in single room (*)
Late registration (after May 31, 2006)
450 EUR per person in double room (*)
500 EUR per person in single room (*)
On-site registration (September 3 – 5, 2006)
600 EUR per person in double room (*)
650 EUR per person in single room (*)
(*= accommodation during the field trip)

I WISH TO SHARE A DOUBLE ROOM WITH: 
In case of exchange rate changes by more than 5 % Conference Partners Prague Ltd. has the right to modify prices.
TOTAL PAYMENT:
Automatic summarization of total payment:    EUR
I will send a copy of the bank transfer of the total amount of   EUR
  Bank account No.: 176970780 / 0300 of the Conference Partners Prague Ltd., at the
Československá obchodní banka a.s., Anglická 20, 120 00 Prague 2, Czech Republic.
IBAN: CZ64 0300 0000 0001 7697 0780, BIC: CEKOCZPP
 
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
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)