11th Prague – Weizmann Summer School
registration - step 1

Please check the contents of this form carefully as you will not be able to make modifications after submission.
If it is necessary to change any information after submission, please contact the Conference Secretariat.

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1. Personal Data

Title, Given Name

Surname, Title

Affiliation

Address

City

ZIP Code

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Telephone+ (+420 123456789)

E-mail

2. Registration fees

Registration fee includes:

• Admission to the scientific programme
• Conference materials
• Coffee breaks, lunches
• Welcome party

3. Dietary Requirements:

Lactose free

Gluten free

Vegetarian

Vegan

4. Accommodation

 I would be interested in receiving an accommodation proposal

5. Abstract

I would like to present poster

6. Payment

• Credit Card - Push payment system

  Congress Business Travel will generate a unique payment link for each participant, which will be sent to their email address within 5 business days.

  The link will remain valid for a few days, as indicated in the email. If you choose to pay via PUSH payment, simply click on the link, and your browser will redirect you to the GPwebpay payment gateway.

  GPwebpay - Global Payments Europe is one of the most widely used payment gateways in the Czech Republic. It is secured with 3D Secure and supports payments from Visa, Mastercard, Eurocard.

• Bank Transfer

  Bank name	Ceska sporitelna
  Bank address	Rytirska 29, 110 00 Praha 1, Ceska republika
  Account number	1942073339
  Bank code	0800
  Account name	Congress Business Travel
  IBAN	CZ63 0800 0000 0019 4207 3339
  SWIFT / BIC	GIBA CZ PX
  Payment details	participant's full name / 222 (e.g. John Smith / 222) (if it is impossible to include the name on the bank transfer kindly mark "222" only)

  Please note that all bank charges should be fully covered by the payer.
  The copy of the bank transfer should be sent by mail to the Conference Secretariat.

7. Payer

 I request a proforma invoice

Different payer of invoice

8. Notes

Please write your requirements (not guaranteed)

9. I agree with the use of my personal data

I agree with the use of my personal data by the company Congress Business Travel spol., s r.o., in accordance with the Czech Personal Information Protection Act 101/2000 Sb. The data will be used solely for the purposes of this symposium; giving consent is a necessary condition of your registration.