Registration Application



Enter Information
Title:*
First Name:*
Last Name:*
Institute/Department:
University/Company:*
Street:*
Zip or Post Code:*
City:*
Country:*
Telephone:*
E-mail:*
I want to register for:*
  Package 1,   780,- € (single room)
  Package 2,   580,- € (double room),   Name of roommate:  
      (The number of single rooms available is limited. All rooms are non-smoking rooms.)
      Packages 1 & 2 include registration fee, all meals, & hotel accommodation.

I will join the dinner on Thursday, February 23:* Yes     No
I will join the reception at the City Hall and dinner on Friday, February 24* Yes     No
I will join the dinner and dance on Saturday, February 25:* Yes     No

Special dietary requirements:  

Please make your own travel arrangements to the meeting venue.
For organizational purposes we need arrival/departure dates and times:
Mode of transport:*   Air     Train     Car
Arrival:
  Arriving City: Arriving Date*/Time (dd/mm 00:00)
Departure:
  Departing City: Departing Date*/Time (dd/mm 00:00)
 
Additional Comments:  

Enter this verification code:*   ewrr2012