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AUA KH * PRIHLASKA / REGISTRATION FORM

Kutna Hora One Day Conference*Seminars-Friday 29 January*29. ledna 2010

10. ročník / 10th ALTERNATIVES

AUA KH * PRIHLASKA / REGISTRATION FORM

Kutna Hora One Day Conference*Seminars-Friday 29 January*29. ledna 2010

10. ročník / 10th ALTERNATIVES 

Under the auspices of the Mayor of Kutna Hora*Pod záštitou starosty města Kutna Hora. Akreditace MSMT ČR

PŘIHLÁŠKA / REGISTRATION FORM

Příjmení / Surname: .........................................................

Jmeno / First Names: ........................................................

(pani, pan, slecna, Mr, Mrs, Ms, Miss, Mgr., Dr., Ing., ...)

Adresa/address:...........................................................................................................................

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Telefonní/faxové číslo Tel./Fax: ......................................... e-mail:..................................................

Škola a zaměstnání / School and Institution where employed:

..................................................................................................................................................

..................................................................................................................................................

Telefonni a faxove cislo Tel./Fax: ......................................   e-mail: ..............................................

Vyučuji předměty / I teach the following subjects: ..........................................................................

Z nabízného programu se nejvíce zajímám o / I am especially interested in

..................................................................................................................................................

 

Konferenční poplatek/Registration Fee (včetěe občerstvení a konferenčních materialů / snack and conference materials included)

Členové asociace/ATECR member do 15. 11. 2009 380,- Kc později 495,-

Ostatni / Others do 15.11.2009 480,-Kc pozdeji 595,-

Obed / Meals: I am a vegetarian yes no (Please Circle)

Úhradu konferenčniío poplatku proveďte na účet asociace/Payment to be made to:

AUA CR Praha 1, Ceska sporitelna, Vaclavske namesti, cislo uctu / account number: 1923416359/0800, variabilni symbol / variable symbol: 29012010

Přihlasku s kopii dokladu o uhrade konferenčniho poplatku vraťte na adresu / Your registration will not be processed until payment has been received. Please enclose a copy of your proof of payment.

Cancellations received before 15th November 2009 will incur a 50% cancellation charge. Cancellations received after 15th November 2009 will not be refunded.

Idealne zaslete prihlasku IHNED *Apply ASAP The number of places is limited  event. do 10. ledna 2010/ Please return this form by 10 January 2010

Kontakt:

Ms. Jana Jilkova, Regionalni centrum AUA CR, ICV, Ostasova 524, 284 01 Kutna Hora

e-mail: jilkova.icvkh@tiscali.cz