To Be Completed Individually for Each Participant

XIII INTERNATIONAL YALTA FINANCE FORUM

September 17 – 21, 2013

PARTICIPANT’S APPLICATION

(to be completed individually for each participant)

Attention! Please complete all fields!

I. BASIC INFORMATION

Participation Category / REGISTRATION FEE
(all prices are in EUR)
If paid after August 10, 2013
1. Full participation fee (accommodation not included) includes:
- Official Forum opening ceremony
- Participant’s case
- Handout materials
- Sponsors’ presentation kit
- Participation in plenary meetings, section meetings and discussions
- Translation (Russian/Ukrainian/English)
- Coffee breaks
- Meals
- Entertainment program
- Official Forum closing ceremony, dinner
- Sightseeing tours
- Transfer from Simferopol to Yalta and back* / 980
Note: Full participation fee (accommodation not included) for several people from one company:
Two to four participants from one company
Five and more participants from one company / discount 5%
discount 10%
2. Participation fee for participant’s family member (registration fee, in condition that such family member stays in the same hotel room with the partisipant)
- Transfer from Simferopol to Yalta and back*
- Official Forum opening ceremony
- Meals
- Entertainment program
- Sightseeing tours
- Official Forum closing ceremony, dinner / 450

* Transfer is arranged on the day of arrival (September 17, 2013) and departure (September 21, 2013) according to the approved schedule (see schedule at www.cbs.org.ua after 04.09.2013).

II. PARTICIPANT INFORMATION

1. PARTICIPATION CATEGORY (please mark the appropriate box):

q Full participation
q Full participation of several people from one company / q Family member participation

2. ORGANIZATION / INSTITUTION / COMPANY NAME:

3. ORGANIZATION / INSTITUTION / COMPANY ADDRESS:

registered address / postal address
Phone: / Fax: / E-mail:

4. PARTICIPANT INFORMATION:

FULL NAME
JOB TITLE
Phone: / Mobile: / E-mail:

5. FOR HOTEL BOOKING, PLEASE PROVIDE THE FOLLOWING DETAILS:

Passport: series / Number: / Day, month and year of birth:
Issued by:
I will arrive on ______September 2013 and will leave on ______September 2013
Please provide the information about time of arrival and type of transportation 2 weeks before arrival.

6. CONTACT PERSON:

FULL NAME
JOB TITLE
Phone: / Mobile: / E-mail:

XIII INTERNATIONAL YALTA FINANCE FORUM

September 17 – 21, 2013

III. ACCOMMODATION

Accommodation per one participant from September 17 to September 21, 2013, Yalta-Intourist Hotel*:

Service / Price per day, UAH. /

Mark

Room category: Standard Room
- single occupancy
- double occupancy / 850
1,050 / q
q
Room category: Standard Superior
- single occupancy
- double occupancy / 1,000
1,200 / q
q
Room category: Junior Suites
- single occupancy
- double occupancy / 1,750
1,950 / q
q
Participants wish to organize their hotel accommodation themselves. / 0 / q

* RULES OF STAYING AT YALTA-INTOURIST HOTEL:

Accommodation fee includes full range of key services of Yalta-Intourist Hotel.

Check-in and payment are regulated by the common check-in time system, i.e. check in startind from 15:00 and check-out before 12:00 local time. In case you wish to stay longer, additional hours of stay shall be paid as follows:

Check-in from 00:00 to 02:59 / full day rate (please specify in the application that you will arrive 1 (one) day before the scheduled arrival date to ensure guaranteed reservation of the room prepared for early arrival. Breakfast included)
Check-in from 03:00 to 14:59 / 50% of the day rate (breakfast included)
If you need to extend the number, participant may apply to the Hotel Reception 2 hours before check-in time, that is, not later than 10:00 am local time. Depending on availability of hotel rooms, your stay may be extended.
Check-out from 14:00 to 00:00 / 50% of the day rate

IV. PAYMENT

¨ Bank transfer ¨ Credit card (letter of guarantee) ¨ Cash (letter of guarantee)
Current account / Sort code
Banc name / IBAN
SWIFT
Taxation system:
Name and position of authorized signatory:

ADDITIONAL SERVICES.

V. CONFERENCE SERVICES. Please provide the following details if there is a need to book a bilateral meeting:

Full name of the company you want to meet / Date, time, duration and place of meeting

VI. ADDITIONAL INFORMATION

q Please provide me information about flights and trains. / q Please inform me if I can give a sponsor’s presentation.

Date ______Signature ______Seal

All prices are given per one person. Payment is accepted in UAH, RUR, EUR or USD at the current exchange rate of the National Bank of Ukraine effective as of the invoice day. All taxes and fees required by Ukrainian laws are included. Any taxes and fees required by laws of other countries shall be covered by the respective participants.

Forum organizer: Perspektiva Business Strategy Centre with support of League of Ukrainian Insurance Companies

Please send the completed application to the Organizing Committee by e-mail or by fax.

Payment shall be done under invoice executed based on your completed application.

Phone/Fax: +3804440-66-555 (multichannel)

E-mail: