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VInternational Carpathian Insurance Conference
16.02.09-19.02.09, Yaremche,
Recreation Centre «Karpaty»
e-mail: tel.: +38 (044) 536 00 19
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APPLICATION FOR PARTICIPATION

! Attention: to be filled in for each individual participant

I.INFORMATION (REGISTRATION FEE)

Participation Category /

REGISTRATION FEE

1. Full Participation (without lodging) includes / If payment is effected prior to
January 16, 2009 / If payment is effected after
January 16, 2009
- Official opening of the Conference. Buffet dinner
- participant’s case
- distribution materials of the Conference
- sponsors’ presentation materials
- participation in the official opening and round tables
-board during the period of the Conference
- synchronic interpretation (Russian/Ukrainian/English)
- coffee breaks between sittings
- cultural program
- Official gala closing of the Conference. Banquet / € 500 / € 550

Note:transfer is organized for Kyiv – Ivano-Frankivsk – Kyiv trainon the day of arrival (February 16, 2009) and the day of departure(February 19, 2009)according to the schedule.

II.PARTICIPANT DETAILS

1. Name of organization / institution / company:

______

2. Legal address: ______

Postal address:______

3. Phone number: (____)______Cell number: (____) ______Fax:(____)______

4. Company e-mail: ______Company web-site address: ______

5. Contact person: ______E-mail:______

6. Please, book one place (first name, middle name, last name):

______

7. Position: ______

For hotel booking, please indicate

8. Day, month, year of birth: ______

9. Passport: serial number______number______, issued by ______

III.LODGING

10. Tick as appropriate:

Hotel “Karpaty”

Cost for one participant lodging from February16 till February19, 2009 *
Attention! The quantity of rooms is limited!
Service / Price for one night, UAH / Please tick
Single room 1stcategory with more comfort:
- for lodging one person in the room
- for lodging two persons in the room / 340
510 / 

Single room 2ndcategory with more comfort:
- for lodging one person in the room
- for lodging two persons in the room / 250
400 / 

Semi-Luxury Room:
- for lodging one person in the room
- for lodging two persons in the room / 385
550 / 

Luxury Room
- for lodging one person in the room
- for lodging two persons in the room / 540
650 / 

Lodging will be found without any assistance / 0 / 

Hotel «Edelveis»

Cost for one participant lodging from February 16 to 19, 2009
Attention!The quantityof rooms is limited!
Service / Price for three nights,
UAH / Please tick
Single Room (SNGL) / 1467 / 
Double room 1stcategory with more comfort:(DBL) / 2193 / 
Double room 2nd category with more comfort:(DBL) / 2055 / 
«Luxury» / 3297 / 

Ноtel«BOKOVEL»

Cost for one participant lodging from February 16 to 19, 2009
Attention!The quantityof rooms is limited!
Service / Price for four nights,
UAH / Please tick
«Luxury» / 6284 / 
«Semi-Luxury» for lodging two persons in the room / 3216 / 
«Semi-Luxury» for lodging three persons in the room / 4208 / 

IV.PAYMENT

11.Form of payment:
Cash payment Bank transfer
12. Bank essential elements:
Account No ______branch name ______sort code______
Bank name______Address of bank ______
Name and position of the person who is authorized to sign an agreement:______

V.ADDITIONAL INFORMATION

13.
I need an assistance in Ukrainian visa obtaining
Please send me the information about the possibility of sponsorship
I need Your assistance in railway tickets booking: 1st class 2nd class 
I would like to arrive on______and leave on______February 2009
I will arrive by own car
14. I think that the following topic(s) would be the most interesting to deal with at the meetings______

15. Information about the Conference I’ve got from______

______

16. Signature ______Date ______Stamp

Prices are indicated in Euro. Payment may be effected in Ukrainian hryvnyas, Russian rubles, or US dollars at cross exchange rate of the National Bank of Ukraine valid on the day of invoice issuing.

All taxes and fees according to legislation of Ukraine are included.

Any other taxes and fees according to legislation of other countries are paid by participants of the Conference by their own account.

Official Organizer of the Conference isBusinessStrategyCenter “PERSPEKTIVA” Ltd.

With the support of theLeague of Insurance Organizations of Ukraine.

Please, send the filled-in application to the Organizing Committee by e-mail or by fax. Payment will be effected in accordance with the invoice made out on the grounds of the filled-in application.

Contact tel./fax: +38044 536 00 19

Contact e-mail:

Detailed information about the Conference: