Registration - step 1

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 contact the Conference Secretariat.

= required field

1. Personal Data

Title, Given name

Surname, Title

Affiliation

City

ZIP Code

Country

Telephone+ (+420 123456789)

E-mail

2. Registration Fee

	EARLY paid before 15 May 2023	REGULAR paid after 15 May 2023	Payment
Fee
Student	EUR 500	EUR 550	EUR
Academic	EUR 590	EUR 640	EUR
Accompanying person	EUR 70	EUR 70	EUR
Accompanying person	pers. × EUR 70		EUR
Excursion ticket (for accompanying person)	EUR 12	EUR 12	EUR
Excursion ticket (for accompanying person)	pers. × EUR 12		EUR
Total			EUR

All fees include VAT.

Academic/Student registration fee includes:

Access to all sessions of the scientific programme and exhibition
Symposium bag, Programme and Book of Abstracts
Certificate of Attendance
Symposium Dinner on Thursday 20 July
Lunch on Thursday 20 July
Free vouchers for two beers per student
Refreshment during coffee breaks
Refreshment during Poster Session on Wednesday 19 July
Option to purchase tickets for excursions

Accompanying person registration fee includes:

Symposium Dinner on Thursday 20 July
Option to purchase tickets for excursions

3. Abstract – submission closed

4. Payment

Credit Card

I authorise 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

Type of card
Name of card holder*
Card number
Expiration date (mm/yy)
CVV/CVC (last 3 digits)**
Invoice address (AMEX)

*) Supposing the card holder name and the name of a participant are different, the Symposium Secretariat might require card holder approval. Please fill in all the required entries. For further detail, please contact the Symposium Secretariat. The Secretariat will send you a special form to be approved.

**) CVC2 (MasterCard/EuroCard) or CVV2 (American Express, Visa, Diners) code is printed on the back side of your credit card in the signature label (last 3 digits).

Bank Transfer

Bank name	Česká spořitelna
Bank address	Václavské náměstí 16, 110 00 Praha 1
Account number	1942073339
Bank code	0800
Account name	Congress Business Travel
IBAN	CZ63 0800 0000 0019 4207 3339
SWIFT / BIC	GIBA CZ PX
Payment details	803 + participant´s full name (for easier identification)

Please note that all bank charges should be fully covered by the payer.
The copy of the bank transfer should be sent by fax or mail to the Symposium Secretariat.

5. Payer

A proforma invoice will be issued upon request. Please write your requirements in Section 6. Notes.

I request a proforma invoice on my name

Different payer of the invoice

Organization name

Invoice address

Mailing Address

City

ZIP code

Country

Contact person

Telephone+ (+420 123456789)

E-mail

VAT

6. Notes

7. Agreement with the Use of my Pesonal Data

I agree with the use of my personal data by the company Congress Business Travel spol., s r.o., in accordance with the Czech Personal Information Protection Act 101/2000 Sb. The data will be used solely for the purposes of this conference; giving consent is a necessary condition of your registration.