BESTInfra 2017 Registration Form

Surname:

First Name:

Title:

Institution/Affiliation:

Address:

Post Code:

Town:

Country:

Phone:

Fax:

E-mail address:

Accompanying Person(s):

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):

Delegate (early-before June 30, 2017 - 380 EUR / late-after July 1, 2017 - 440 EUR)
EUR (please fill in the amount):

Author (early-before June 30, 2017 - 320 EUR / late-after July 1, 2017 - 380 EUR)
EUR (please fill in the amount):

Student(*) ( 200 EUR )
EUR (please fill in the amount):

(*) Please attach a copy of your valid student’s ID if student’s fee applies and send it by email to: bestinfra@conferencepartners.cz

I WILL ATTEND THE FOLLOWING SOCIAL EVENTS:

Welcome drink (September 20, 2017) - included in the registration fee:
YES NO

Conference dinner (September 21, 2017) - 60 EUR:
YES NO

FOR ACCOMPANYING PERSON I WISH TO BUY THE TICKET FOR THE FOLLOWING SOCIAL EVENTS:

Welcome drink (September 20, 2017) - 20 EUR
No. of tickets:

Conference dinner (September 21, 2017) - 60 EUR
No. of tickets:

TOTAL PAYMENT:

I authorize the Conference Partners Prague Ltd.
to charge my credit card with the total payment of EUR (please fill in the sum of all applicable fees):

VISA Eurocard/Mastercard

Card holder’s name (as appears on card):

Card No.:

Expiry date:

I enclose a copy of the bank transfer in the 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 (SWIFT code): CEKOCZPP

(*) Please scan the confirmed bank draft and send it by email to: bestinfra@conferencepartners.cz

Invoicing address: Conference Partners Prague s.r.o., Ke kašně 482/15, 142 00 Prague 4, Czech Republic, ID: 26691671, EU VAT: CZ26691671