If you want to submit by fax, please, use printable version below.
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 fax the changes to the Congress Business Travel Ltd.:firstname.lastname@example.org; fax: +420 224 942 550.
For your convenience the system will remember your personal data and use it in any other forms you submit. The system will forget your personal data if you close this window or stay on this page for more than 60 minutes without submitting.
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Phone+ (+420 123456789)
Rooms are reserved for the period of August 19 –24, 2018 with possibility of additional nights on request.
Capacity in all hotels is limited, rooms will be allocated on a first-come, first-served basis.
Clarion Congress Hotel Prague – Conference venue offeres a special price – Early Bird Rate valid till June 15, 2018.
Date of Arrival (dd.mm.yyyy)
Date of Departure
Number of nights
All hotel extras e.g. garage, minibar, phone costs, room service etc. must be settled directly with the hotel upon departure.
Price per room and night including breakfast and VAT.
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 or invoice.
Invoice addressMailing Address
Phone+ (+420 123456789)
VAT number your institution
Your Invoice PurchaseOrder Number
To guarantee our special congress discounted prices the full pre-payment is requested.
I authorize Congress Business Travel Ltd. (Lidicka 43/66, 150 00 Prague 5, Czech Republic, VAT number: CZ26424053) to charge my credit card for the payment of the above sum EUR: According to the Czech law, credit cards will be charged in local currency / Czech Crowns (CZK) by actual exchange rate.
Card typeSelectAmerican ExpressVISAMasterCard/EuroCardDiners
Card holder's name*
Expiry date (mm/yy)
CVV/CVC code (last 3 digits)**
Billing address (AMEX)
*) In case the name of the cardholder and name of the registered delegate is different, the conference secretariat has the right to ask the cardholder for verification. Please fill in all the requested data and contact the conference secretariat for further details. The secretariat will send you a special form for verification.
**) The 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).
Please note that all bank charges must be fully covered by the remitter.
A copy of the bank transfer should be sent by fax or mail to the Congress Business Travel Ltd. – fax: +420 224 942 550, e-mail: email@example.com. The copy of the bank transfer will help to identify your payment more easily. When sending the fax please do not forget to mark the name of the participant on it!
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.
Please add any information you regard as important
Organizing Secretariat Congress Business Travel Lidicka 43, Prague 5
Phone: (+420) 224 942 575, 224 942 579 Fax: +420 224 942 550 Email: firstname.lastname@example.org http://igelu.org