Family Name First Name Degree

Institution (University)
Department (Faculty)
Address
Country

E-mail

WWW-personal WWW-institutional

Phone Fax

The above data can be made available to public over Internet and or ECM-18 CD-ROM. If there are any data you don't like to be published, please, let it know to the Conference Secretariat.

I would like to present : Oral contribution, Poster

Title :

in section A. Physics, Applied Crystallography B. Materials, Materials Science C. Chemistry, Chemical Crystallography D. Biology E. Advanced Methods F. General Problems, Discussion Meetings , topics 1 2 3 4 5 6 7 8
OR

in section A. Physics, Applied Crystallography B. Materials, Materials Science C. Chemistry, Chemical Crystallography D. Biology E. Advanced Methods F. General Problems, Discussion Meetings , topics 1 2 3 4 5 6 7 8
OR

I think that it cannot be included in any of those.

The abstract is/has been sent by FTP, E-mail, Mail on (date)

Proposed form of written contribution:

Collected abstracts only ,
Abstracts + post conference book with review papers ,
Abstracts + full-length paper in journal

ECM-CD ROM

I would like to include the following program in ECM-18 CD-ROM

Size in kB

We would really appreciate, if you can indicate which microsymposium will probably be of interest for you each conference day.

I am interested in the following workshops:

Accompanying persons

Family Name First Name

Family Name First Name

Family Name First Name

Please, send E-mail message if you need more.

Conference fees and payments (in USD)

(Please, fill in the column “Paid” with the fee you pay)

Hotel Reservation

Please, select two choices for hotel/dormitory (see also)

Hotel/Dormitory: 1st choice Palace Diplomat Praha Holiday-Inn Belvedere Splendid Pyramida Krystal Lunik Koruna Orlik Kajetanka Sinkule Estec-Strahov , 2nd choice Palace Diplomat Praha Holiday-Inn Belvedere Splendid Pyramida Krystal Lunik Koruna Orlik Kajetanka Sinkule Estec-Strahov

Number of beds: 1st choice Single occupation Double occupation Twin beds , 2nd choice Single occupation Double occupation Twin beds

Arrival date : August , Departure date: August

I would like to share the room with

HOTEL DEPOSIT PAID USD (Subtotal B)

Leisure and Ladies Programme

(please, fill in the column "Paid" with the fee you paid)

Total Payment:

I paid total amount of USD (A+B+C) on (date)

By bank transfer to:
Account name: Krystalograficka spolecnost Account No.: 34833/046526001266/068
Bank: Ceska sporitelna, Vitezne namesti 14, 162 06 Praha 6, Czech Republic
Use payment symbol: 270

By the enclosed check (IMO possible) payable to:
Krystalograficka spolecnost, Heyrovskeho namesti 2, Praha 6

By credit card: Visa, American Express, Master/Eurocard (must be sent by snail mail)

Cardholder Name:
Cardholder Address:

Card Number:
Expiration date:

I hereby authorize TBS Bartolomejska 9, 110 00 Praha 1, Czech republic to charge the a.m. credit card for the total amount of

.......................... USD for registered services.

Date:

Signature:

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After submitting the registration form you should get back a page with your registration data.

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