Cancellation and Refund Request Form

Cancellation and Refund Request Form

To cancel your participation in the International Council on Archives (ICA) International Congress 2016.

Please fill out this request form and send it to the Secretariat of the ICA International Congress 2016 by

e-mail () by July 31, 2016.

* All dates and times are on Korean Standard Time (GMT+9).

1. Participant Information / * Please provide your information.
▪ Name / (FirstName, FmailyName)
▪ Gender / □ Male □ Female
▪ Tel
▪ Country
▪ Address
▪ ICA Member / ICA ID ( - )
Affiliation / Organization
Department
Title
Student / Academic Institution
Department
▪ E-mail(ID)
2. Registration Fees
Category / Early bird Registration
(By July 31, 2016) / Pre-Registration
(By September 1, 2016)
Full
Registration / ICA member / □ EUR 450 / □ EUR 550
Non-member / □ EUR 500 / □ EUR 700
Student / □ EUR 250 / □ EUR 350
Daily
Registration / ICA member / □ EUR 150 / □ EUR 225
Non-member / □ EUR 225 / □ EUR 300
Student / □ EUR 112 / □ EUR 150
Daily Registration Date / □ Sep 5, 2016 □ Sep 6, 2016 □ Sep 7, 2016 □ Sep 8, 2016 □ Sep 9, 2016
3. Payment Method / * Please provide your payment information.
Payment Method / □ Credit Card □ Bank Transfer
Credit
Card / Card Type
Card Number / Expiry Date / (MM/YY)
Holder’s Name / CVC
Sign
Bank
Transfer / Sender’s Date / Bank Name
Sender’s Name / Account No.
4. Bank Account for Refund / * Beneficiary must match the Sender’s Name.
Bank/Branch / Account No.
Beneficiary
Swift Code / Bank Address

- Next Page Continues -

• Cancellation & Refund Policy

1. Any change or cancellation must be registered in written form and sent to Secretariat of the ICA International

Congress 2016 via e-mail ()

2. All bank service charges and administration fees will be deducted from your congress registration refund.

3. All approved refunds will be processed two weeks after the Congress.

4. Please note that refunds for accommodation will be handled separately by the Agency in charge of accommodation

reservations, Kim’s Travel Agency.

Date / By July 31, 2016 / After August 1, 2016
Amount to be
Refunded / 25% of the total amount will be deducted,
and the rest will be refunded / No Refunds

I agree with the terms and conditions as stated in this form.

Date . Applicant’s Name .

Signature .

Secretariat of the ICA Congress 2016

Daewang Pangyo-ro 851rd #30, Sujeong-gu, Seongnam, Gyeonggi-do 13449, Korea

Tel. +82-70-4814-2963 E-mail.