27 Annual Meeting of the European Thyroid Association

8TH INTERNATIONAL SYMPOSIUM ON BRITTLE MATRIX COMPOSITES
23 – 25 OCTOBER 2006,
WARSAW, POLAND
TO BE RETURNED: GLOBAL WINGS Ltd.
84/92, Marszałkowska str., 00-514 Warsaw, Poland
tel. (++48 22) 870-09-33,34
fax (++48 22) 621-72-91
e-mail: [email protected].
First Name
Please print or type
Surname
Personal address
Area Code
Tel.
Company
Accompanying person
City
Fax
Country
e-mail
HOTEL CATEGORY
(Price are in EURO per night/room for bed and breakfast)
HOTEL
SINGLE
DOUBLE
GROMADA CENTRUM ***
EURO
85
98
HARENDA **
EURO
80
88
TERMS OF PAYMENT
Please fax us the following credit card details in order to guarantee the hotel reservation: TYPE, NUMBER, EXP.DATE, OWNER’S NAME,
ADDRESS, authorization signature.
Forms together with payment should be received not later than August 5th, 06. Deadline for cancellations: August 15th, 06
After this date the charge for one night will be debited, without exception, and there will be no reimbursement.
Polish participants can pay in PLN at actual exchange rate.
Please reserve:
ROOM
IN
OUT
HOTEL
…….. single room
† GROMADA
† HARENDA
…….. double room
† GROMADA
† HARENDA
TOTAL AMOUNT EURO …………………….…..
PAYMENT
Bank transfer to:
GLOBAL WINGS; 84/92, Marszałkowska str,; 00-514 Warszawa
BRE BANK O/REGIONALNY, 14 KRÓLEWSKA str. 00-950 Warsaw, Poland
Account: for EURO: PL 91 1140 1010 0000 2926 6700 1003
for PLN:
48 1140 1010 0000 2926 6700 1001
SWIFT: BREXPLPWWA1
† VISA † AMEX †MASTER † EURO
Credit Card:
NO CHECKS ARE ACCEPTABLE.
Number :
/bank costs will be
Exp. Date:
added + 5%/
Address of card’s holder:
Name of cardholder:……………………………………………….
Date: ………………………………..
SIGNATURE .................................................................
HOTEL
accommodation
FORM