PDD 2010 - REGISTRATION AND ACCOMMODATION FORM

PRAGUE DENTAL DAYS

Prague, October 6 - 8, 2010,
Prague Congress Centre

REGISTRATION AND ACCOMMODATION FORM
Please complete and return to the Czech Dental Chamber - PDD, Slavojova 22, 128 00 Prague 2, Czech Republic
before August 10, 2010 (low prices)

* Surname:	* Firstname:
* Mailing address:	* Postal code:
* City:	* Country:
* E-mail:	phone number:
Accompanying person(s) ... 35 EUR
Surname:	Firstname:
Surname:	Firstname:

Attn: fields marked with * are required

REGISTRATION FEES	before 10 Aug 2010	11 Aug - 24 Sept 2010	after 24 Sept 2010 and on site
Dentist (non-member of the ČSK, SKZL)	300 EUR	350 EUR	360 EUR
Dental Assistant, Dental Hygienist	100 EUR	150 EUR	160 EUR
Dental Student	100 EUR	110 EUR	115 EUR

SOCIAL PROGRAMME	persons	price	Total
Black Light Theatre – Wednesday, 6 Oct		20 EUR

ACCOMMODATION
Arrival date (dd.mm.yy):	Departure date (dd.mm.yy):	Number of nights:

	single room	double room	Total
Corinthia Prague*****	115 EUR	130 EUR
Hotel Holiday Inn****	99 EUR	99 EUR
Hotel Park Inn****	85 EUR	92 EUR
Hotel Prague Centre***	72 EUR	82 EUR
Hotel Beránek***	68 EUR	88 EUR
			I am sending deposit: EUR

I am sending Total amount: EUR

Deposit
All hotel accommodation bookings must be accompanied by a minimum one night’s payment in order to secure your reservation. Without payment we are unable to guarantee your room.

Notes: