FSSCEF-2004 Staff use only
June 17 - 20, 2004 St. Petersburg Russia Registration No.______
Please complete this form and return it for Advance Registration to FSSCEF-2004
to Monomax Ltd., FAX: +7 (812) 324-7322, E-mail: firstname.lastname@example.org
Title: _____________First Name _______________________Last Name_________________________________
Date of birth__________________ Passport number____________________ Citizenship ____________________
Issued: ___________________ Valid until: ____________________
Position _________________________ Institution, Company ___________________________________________
Street Address ___________________ City ________________ Zip ________ Country ______________________
Phone _______________________ Fax _____________________________ E-mail _________________________
Accompanying Person’s Name ____________________________________________________________________
If you need visa invitation indicate the dates of staying in the Russian Federation ____________________________
1 I am invited speaker 1 I will present a paper /poster # 1 I have no presentation
^ invitation, three days of the conference, including one lunch daily, coffee-brakes, participant's kit, one copy of the conference proceedings, conference banquet on boat, transportation from and to airport upon arrival and departure, and one city tour, including the Hermitage visiting.
^ invitation, one lunch daily, coffee-brakes, conference banquet on boat, transportation from and to airport upon arrival and departure, one city tour, including the Hermitage visiting.
Cancellation of registration before May, 15: refund is 100% of charge minus RUR 350 (bank fee)
Cancellation of registration after May, 15: no refund.
Additionally: Deluxe 5670 ( Luxe 6300 (
The rates are given as for 1.12.2003.
Check in – check out time is 12:00. (TAKE INTO ACCOUNT THAT 50% OF PRICE PER NIGHT IS CHARGED IF YOU CHECK-OUT AFTER 12:00!!!!!)The rates include Rates include buffet breakfast, taxes and passport registration fee.
!!! Deadline for hotel reservation is May 25, 2004. After this date requests for hotel accommodation are accepted but without guaranteed reservation.
!!! Deadline for cancellation is May 27, 2004. In case of late cancellation or no show the charge of one night’s accommodation is to be paid.
(Covered by registration fee. Please, fill-in carefully to be met for sure!!)
Please, note: Registration fee and hotel accommodation can be paid separately.
Please, choose if you pay BY BANK TRANSFER OR CREDIT CARD:
IMPORTANT NOTICE: Bank transfer fee is paid by the declarant
TOTAL SUM TO BE PAID ________________ + $7 (on site bank fee) = _______________________
I authorize MONOMAX to charge my credit card:
( Visa ( Euro/Mastercard ( Diners ( American Express
Expiry Date: ______ / ______ CVC: _____________
Name ___________________________ (as it appears on card)
TOTAL SUM TO BE PAID ____________________ +3% (bank fee) = _________________________
CARD HOLDER’S SIGNATURE ______________________
Date __________________ Signature ___________________
By signing this form, I declare to accept all conditions of participation in the Conference.
The amount of Conference registration and other fees are defined in Russian Rubles. The amount to be paid in other currencies must be counted according the current rate. (The official rate of Russian Central Bank is available at http://stock.rbc.ru/demo/cb.0/intraday/ , to convert RUR into other currencies you may visit http://xe.com/ucc )
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