Registration - step 1 | 5th Symposium Cutting Edge of Laboratory Medicine in Europe CELME 2023

FIRST ANNOUNCEMENT:

Organizing OFFICE:


Congress Business Travel spol. s r. o. Lidická 43/66, 150 00 Praha 5 - Anděl
Phone:	+420 224 942 575 +420 224 942 579
Fax:	+420 224 942 550
E-mail:	celme2023@cbttravel.cz

On-line Registration

Please check the contents of this form carefully as you will not be able to make modifications after submission. If it is necessary to change any information after submission, please e-mail or a fax the changes to the Organizing Office: celme2023@cbttravel.cz; fax: +420-224 942 550.

For your convenience the system will remember your personal data. The system will forget your personal data if you close this window or stay on this page for more than 30 minutes without submitting.

We have limited number of seats – we can accept only 120 participants, we recommend to provide your on line registration on time. The confirmation will be based upon first come first served rule.

= required field

I. Personal Details

Title, First Name

Family Name, Title

Address

City

ZIP code

Country

Phone+ (+420 123456789)

Fax+ (recommended)

E-mail

II. Registration

	Early paid before June 30, 2023	Late fee valid after June 30, 2023	payment
Regular fee	130 EUR	150 EUR	EUR
Invited speaker	0 EUR	0 EUR	EUR

Registration fee includes:

Admission to the scientific programme
Conference materials
Coffee breaks, Lunch

III. Accommodation

I require accommodation

Single Room	Double Room
More details Hotel Betlem Club
Single room EUR 90 Single room attic EUR 80	Double room EUR 115 Double room attic EUR 110
More details OLD PRAGUE HOTEL
Single room EUR 99	Double room EUR 109
More details Hotel Adria
Double room Solo Use EUR 130	Double room EUR 140
Total accommodation	EUR

Total

Total			EUR

IV. Payment Instructions

Credit card

If you enter an incorrect credit card number, or if your credit card is not authorised for another reason, the registration process will be cancelled automatically.

I authorize Congress Business Travel Ltd. (Lidická 43/66, 150 00 Prague 5, Czech Republic, VAT number: CZ26424053) to charge my credit card for the payment of EUR:

Card type
Card holder's name*
Card No.
Expiry date (mm/yy)
CVV/CVC code (last 3 digits)**
Billing address (AMEX)

*) In case the name of cardholder and name of registered delegate is different, Conference Secretariat has the right to ask cardholder for approval. Please fill in here all requested details and contact the Conference Secretariat for further details. Secretariat will send you a special form for verification.
**) CVC2 (MasterCard/EuroCard) or CVV2 (American Express, Visa, Diners) code is printed on the reverse side of your credit card on the signature panel, (last three digits).

Bank transfer

Bank name	Ceska sporitelna
Bank address	Vaclavske namesti 16, Prague 1, Czech Republic, 110 00
Account number	1942073339
Bank code	0800
Account name	Congress Business Travel
IBAN No.	CZ63 0800 0000 0019 4207 3339
SWIFT/BIC	GIBA CZ PX
Payment details	participant's full name / 807 (e.g. John Smith/807) (if it is impossible to include the name on the bank transfer kindly mark "807" only)

V. Billing Details

In case you need to issue an invoice or if someone else is paying your registration fee, please, tick the following box.

If you require pro-forma invoice, please state it in the VI. Notes section.

Different payer of the invoice

Organization name

Invoice address

Mailing Address