Xi International Carpathian Insurance Conference

Xi International Carpathian Insurance Conference

XI INTERNATIONAL CARPATHIAN INSURANCE CONFERENCE
February 18-21, 2015
Ukraine, Yaremche, SPA Hotel «ROMANTIK 4*»
e-mail:
Phone/Fax: +38 044 406 65 55 – multichannel
/

APPLICATION FORM

(to be completed individually for each participant)

Attention! Please complete all fields!

I.BASIC INFORMATION

PARTICIPATIONCATEGORY /

REGISTRATION FEE

(price is in EUR)
Full Participation fee (accommodation excluded) includes: / If paid before February05, 2015 / If paid after
February05, 2015
  • official opening of the Conference
  • participation pack
  • conference kit
  • participation in plenary meetings, section meetings and discussions
  • meals
  • coffee breaks
  • entertainment program
  • sightseeing tour
  • official Conference closing ceremony
  • transfer Ivano-Frankivsk - Yaremche*
  • transferYaremche-Ivano - Frankivsk*
/ 450 € / 490 €

* Transfer is arranged only on the day of arrival (February 18, 2015) and departure (February 21, 2015) according to the approved schedule (see schedule at

  1. PARTICIPANT INFORMATION

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

Full participation / Full participation of several participants from one Company

2. ORGANIZATION / INSTITUTION / COMPANY NAME:

3. ORGANIZATION / INSTITUTION / COMPANY ADDRESS:

Legal address: / Postal address:
Telephone: / Fax: / E-mail:

4. PARTICIPANT INFORMATION:

FULL NAME
JOB TITLE
Telephone: / Mobile phone: / E-mail:

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

Passport: series / Number: / Day, month and year of birth:
Issued by:
I wish to arrive on ______and leave on ______of February 2014
Please provide details on time of arrival and type of transportation 2 weeks before arrival.

6. CONTACT PERSON:

FULL NAME
JOB TITLE
Telephone: / Mobile phone: / E-mail:

III. ACCOMMODATION (please mark the appropriate box):

SPA Hotel «ROMANTIK 4*»

Lodging per one participant from February 18 to February 21, 2015
Please notice! The amount of rooms is limited!
Service / Price per night, UAH / Mark
Room category: Standart
- single occupancy / 1020 / 
- double occupancy / 1440 / 
Room category:Luxury
- single occupancy / 1640 / 
- double occupancy / 2340 / 
Room category:Apartments
- double occupancy / 3740 / 
- occupancy of four people / 3880 / 
Lodging will be arranged without assistance / 0 / 

IV. PAYMENT

 Bank transfer /  Cash payment (letter of guarantee)
Current account / Sort code
Bank name / IBAN
SWIFT code
Full name and job title of the authorized person who signs contracts:

V. TRANSFER (please mark the appropriate box):

Transfer is organized on the day of arrival (February 18, 2015) and the day of departure (February 21,2015) according to the schedule (see at

Please provide us with information in order for the organizers to arrange transfer no later than 2 weeks prior the Conference.

Ivano-Frankivsk AIRPORT (please specify your flight number and arrival time)
Arrival day / Departure day
 / Ivano-Frankivsk RAILWAY STATION (please specify the number of the train and arrival time)
Arrival day / Departure day
 / The issue of transfer is solved independently

Date ______Signature______Stamp

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.

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

Please send the completed application to the Organizing Committee by email or by fax.

Payment shall be done according to provided invoice with pricing based on completed Application Form.

Contact tel./fax: +3804440 66 555 – multi-channel

Contact e-mail:

Detailed information:

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