REGISTRATION FORM
EUROPEAN RADIATION RESEARCH 2004
PLEASE PRINT, COMPLETE & SEND THIS REGISTRATION FORM EITHER BY FAX OR EMAIL TO THE CONGRESS SECRETARIAT
FAX: +36-1-202-1216
EMAIL:
Please, use CAPITAL LETTERS
Title: Mr. 0 Mrs. 0 Ms0 Prof. 0 Dr. 0
Family name:______
First name:______
Company:______
Department:______
Street, N°:______
P.O. Box (if applicable): ______
Postal/Zip Code: ______
City: ______
State (if applicable): ______
Country:______
Telephone work (including country & city codes): ______
Telephone home (including country & city codes): ______
Fax (including country & city codes): ______
E-mail:______
Registration Fee (in Euro):
Early registration (until May 31, 2004)
Amount
E.S.R.B. members 250 € ______€
Non members 290 € ______€
PhD Students 180 € ______€
Accompanying persons 90 € ______€
Late registration (after June 01, 2004)
E.S.R.B. members 310 € ______€
Non members 350 € ______€
PhD Students 240 € ______€
Accompanying persons 130 € ______€
Registration fee for regular participants includes:
Welcome Reception
Book of Abstracts
Admission to scientific sessions and posters
Refreshments during breaks
Congress dinner
This fee does not include lunches.
Lunch:
August 26, Thursday
0 Hot Lunch (12€) ______€
August 27, Friday
0 Hot Lunch (12€) ______€
August 28, Saturday
0 Hot Lunch (12€) ______€
Social Program
August 25, Wednesday
0 Welcome reception
August 27, Friday
0 Conference dinner
Both social events are included in the registration fees.
Accommodation
1. Hotel Agro***
Single room/night 65 €
Double room/night 70 €
2. Hotel Normafa****
Single room/night 85 €
Double room/night 105 €
For hotel details, see the Accommodation section and the corresponding Website.
One night’s deposit is necessary to secure the reservation. The outstanding balance should be paid at the Congress Secretariat after arrival. Alternatively, the entire hotel bill might be paid at the time of registration by bank transfer.
I wish to stay at ______Arrival: ______Departure: ______
Number of nights: ______Single/double room______
One night deposit for hotel room: ______€
or
Whole payment for hotel room: ______€
Total ______€
Method of Payment
Please, pay the fees by bank-to-bank transfer (in Euro) to:
Bank Name: K&H Bank Ltd.
Bank address: 1055 Budapest, Gerlóczy u. 9-11. Hungary
Account name: Hungarian Biophysical Society
Account number: 10200830-32310078
IBAN: HU45 1020 0830 3231 0078 0000 0000
Swift code: OKHBHUHB
Reference: ESRB2004
Transfer should be free of charge to receiver.
The early registration fee should reach the Congress Secretariat until May 31, 2004. The late registration fee should be received not later than August 10, 2004. After this date onsite registration is possible. For onsite registration, please add 10 € to each category of the late registration fees.
Date: Signature: