First name Family name Degree

Institute, university
Department, faculty
Address (street)    

City

E-mail Tel. Fax

I would like to present poster.

Title, comments:

Accommodation and meals

Whole colloquium (June 17 dinner to June 21 lunch).

(from dinner to lunch following day)

June 17 - 18 June 18 - 19 June 19 - 20 June 20 - 21

The payment for shorter stay is not preferred. However, it is possible, if necessary.

I am interested in bus transportation

June 17 from Ostrava to Ostravice (around lunch time)
June 21 from Ostravice to Ostrava (after lunch)
I will arrive by my own car

I prefer to stay in wooden cottage

I prefer to share room with    

Fee of   CZK has been (will be) paid (date)