Registration Form icon

Registration Form



НазваниеRegistration Form
Дата конвертации14.09.2012
Размер38.85 Kb.
ТипRegistration form

FSSCEF-2004 Staff use only

June 17 - 20, 2004 St. Petersburg Russia                                  Registration No.______      

Registration Form


Please complete this form and return it for Advance Registration to FSSCEF-2004

to Monomax Ltd., FAX: +7 (812) 324-7322, E-mail: vipservice@monomax.org

http:// www.monomax.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 ____________________________

CONFERENCE REGISTRATION

1 I am invited speaker 1 I will present a paper /poster # 1 I have no presentation
^

Registration Fee (Please fill in your payment)




Technical Program

Jun 17– Jun 21, 2004

Early registration

(Before May 1, 2004)

Late registration

(After May 1, 2004)

Participants

1 11020

1 12470

Accompanying person

1 5220

1 6090

^ Registration fee covers: 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.


^ Registration fee for accompanying person(s) covers 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 policy

Cancellation of registration before May, 15: refund is 100% of charge minus RUR 350 (bank fee)

Cancellation of registration after May, 15: no refund.

SUB-TOTAL ________________

Hotel accommodation


^ Conference service agency – Monomax Ltd. - offers accommodation in the hotel “Saint-Petersburg” ***




Sgl per night

Mark

Dbl per night

Mark

Dates of staying

^ HOTEL “SAINT-PETERSBURG”***

5/2, Pirogovskaya emb.


Standart 2520


Renovated 3476

(


(

Standart 3265


Renovated 4410

(


(


From _____________ till _______________


Arr. time__________ Dep. time __________

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.
^

To avoid problems with reservation you are recommended to send this form as soon as possible.


!!! 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.

SUB-TOTAL ________________


Transfer

(Covered by registration fee. Please, fill-in carefully to be met for sure!!)

Date of arrival

Time of arrival

Flight/train number










Date of departure

Time of departure

Flight/train number











^ WAYS of Payment

Please, note: Registration fee and hotel accommodation can be paid separately.

Please, choose if you pay BY BANK TRANSFER OR CREDIT CARD:

    1. USD bank transfer to:

      Beneficiary

      Bank

      Bank address


      SWIFT - address

      Account number

      Account number in IBAN format

      Moreno International Services Inc.

      Nordea Bank Finland Pсl

      1200 Helsinki - WTS branch,

      Aleksanterinkatu 17, 00100, Helsinki, Finland

      NDEAFIHH

      120042-1343

      FI27 1200 4200 0013 43

    2. EUR bank transfer to:

Beneficiary

Bank

Bank address


SWIFT - address

Account number

Account number in IBAN format

Moreno International Services Inc.

Nordea Bank Finland Pсl

1200 Helsinki - WTS branch,

Aleksanterinkatu 17, 00100, Helsinki, Finland

NDEAFIHH

120030-42564

F192 1200 3000 0425 64

IMPORTANT NOTICE: Bank transfer fee is paid by the declarant

TOTAL SUM TO BE PAID ________________ + $7 (on site bank fee) = _______________________


    1. credit card (in case of credit card payment a fax copy with cardholder’s signature is required, please, fax it to +7 812 324 7322):


^ Please, note that in case of credit card payment 3% for banking operation is retained.

I authorize MONOMAX to charge my credit card:

( Visa ( Euro/Mastercard ( Diners ( American Express

















































Card nr.

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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