offline prijava - SPEKTAR PUTOVANJA doo

PRIJAVA ZA
SUDJELOVANJE
I HOTELSKI SMJEŠTAJ
REGISTRATION &
ACCOMMODATION FORM
Molimo ispunite prijavu i pošaljite na:
SPEKTAR PUTOVANJA d.o.o., Tkalčićeva 15, 10000 Zagreb, Hrvatska, T: +385 1 4862 611 F: +385 1 4862 622, E: [email protected]
Please complete this form and return it to:
SPEKTAR PUTOVANJA d.o.o., Tkalčićeva 15, 10000 Zagreb, Croatia, T: +385 1 4862 611 F: +385 1 4862 622, E: [email protected]
Molimo Vas da koristite velika tiskana slova_Please use block letters
INFORMACIJE O SUDIONIKU_PARTICIPANT INFORMATION
Prezime_Family Name ................................................. Ime_First Name ..................................................... Titula_Title ........................
Ustanova/Institucija/Bolnica_Department/Institution/Hospital ..............................................................................................................
Profesija_Profession .............................................................................. Adresa_Address ......................................................................
Poštanski broj_Zip Code ......................................... Grad_City ................................ Država_Country .....................................................
Telefon_Phone ..................................... E-mail_E-mail .............................................................. Faks_Fax ..............................................
KOTIZACIJA_REGISTRATION FEE
KATEGORIJA
CATEGORY
RANA DO 10.05.2015.
EARLY TILL MAY 10th 2015
KASNA OD 11.05.2015. DO 28.05.2015.
LATE FROM MAY 11th TILL MAY 28th 2015
U VRIJEME ODRŽAVANJA
SIMPOZIJA_ON-SITE
Dr.med., specijalist
750,00 kn
800,00 kn
850,00 kn
Dr.med., specijalizant/student
450,00 kn
500,00 kn
550,00 kn
Ostali
800,00 kn
850,00 kn
900,00 kn
Kotizacija uključuje:
Tiskane materijale Simpozija
Pristup predavanjima i izložbenom prostoru
Kave tijekom stanki
Registration fee includes:
Printed materials
Admission to all Symposium sessions and Exhibition area
Coffee during breaks
SMJEŠTAJ_ACCOMMODATION
HOTEL
HOTEL
JEDNOKREVETNA SOBA
SINGLE ROOM
DVOKREVETNA SOBA
DOUBLE ROOM
742,00 kn
927,50 kn
Hotel Dubrovnik 4*
Osoba u pratnji u dvokrevetnoj sobi/ Accompanying person in DBL room: .................................................................................................
Datum dolaska/ Arrival date : ............................................... Datum odlaska/ Departure date : ...............................................
Cijene smještaja izražene su po sobi/danu te uključuju
noćenje/doručak,
PDV i boravišnu pristojbu.
Za mogućnost rezervacije drugih datuma za smještaj molimo
kontaktirati [email protected]
Rates are per room per day and include bed&breakfast service,
VAT and city tax.
For reservations before and after the Symposium dates, please
contact [email protected]
Important: Accommodation will be confirmed upon receipt of
the payment.
UVJETI OTKAZIVANJA SMJEŠTAJA
Otkazivanje je moguće jedino pismenim putem na adresu Spektar
putovaja d.o.o., Tkalčićeva 15, 10000 Zagreb
Za sve otkaze smještaja zaprimljene do 15.05.2015. izvršiti će se povrat od
50% uplaćenog iznosa za hotelski smještaj + 180,00 kn za administrativne
troškove.
Nakon 15.05.2015. povrat nije moguć.
CANCELATION CONDITIONS
All cancelations must be sent in writing to Spektar putovanja d.o.o.,
Tkalčićeva 15, 10000 Zagreb, Croatia
th
For all cancelations received before May 15 , 2015 a refund of 50% of
the registration fee minus handling fee of 25 EUR will be made
th
After May 15 , 2015 there are no refunds.
INFORMACIJE ZA RAČUN_INVOICE INFORMATION
Sve troškove Simpozija snosim sama/sam / I will cover all Symposium expenses by myself
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Pravna osoba/frima snosi sve ili djelomične troškove / Institution/Company will cover all or some Symposium expenses
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Pravna osoba snosi troškove za / Institution/Company will cover following expenses:
Kotizacija / Registration fee
□
Hotelski smještaj / Hotel accommodation
□
PODACI O PRAVNOJ OSOBI / INSTITUTION/COMPANY DETAILS
Tvrtka / Company .......................................................................... OIB/ VAT.................................................................................
Adresa / Address ...........................................................................................................................................................................
Tel ......................................................................... Email.............................................................................................................
NAČIN PLAĆANJA_METHOD OF PAYMENT
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Plaćanje je potrebno izvršiti unaprijed u kunama u korist agencije "Spektar putovanja" d.o.o.
Bankovna uplata na žiro račun agencije Spektar putovanja, s naznakom naziva događaja, imenom i prezimenom
sudionika te pozivom na broj 018/003/2015
Kreditna kartica offline: American Express, Diners, Eurocard/Mastercard, Visa
Prilikom online prijave na ovoj internet stranici i odabira plaćanja kreditnom karticom offline preuzeti ćete offline obrazac
za autorizaciju kreditne kartice. Ispunjeni obrazac šalje se mailom ili fax-om organizatoru kongresa.
Kreditna kartica online: American Express, Diners
Prilikom online prijave na ovoj internet stranici i odabira plaćanja kreditnom karticom online, biti ćete preusmjereni na
sigurnu (128-bit SSL enkriptiranu) T-com PayWay stranicu gdje će se obaviti online plaćanje.
Gotovina na blagajni Spektar putovanja, Tkalčićeva 15, 10000 Zagreb, Hrvatska
Broj žiro računa za uplate u kunama
Spektar putovanja d.o.o.
ZAGREBACKA BANKA ZAGREB
IBAN HR3923600001101441264
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Payment should be done in advance, in kuna, on the account of agency Spektar putovanja d.o.o.
Bank transfer - bank transfer payment should be made payble to Spektar Putovanjad.o.o. The participant's full name and
the reference number 018/003/2015 should be included with the payment.
Credit card offline: American Express, Diners, Eurocard/Mastercard, Visa
For the credit card offline payment, please download the authorization form, which, after filled in, should be sent by mail
or fax to the technical organizer Spektar putovanja.
Credit card online: American Express, Diners
For the credit card online payment you will be redirected to the secure T-com PayWay web page (128-bit SSL encripted),
to finalised your payment.
Cash at Spektar putovanja, Tkalčićeva 15, 10000 Zagreb, Croatia
Account information for payment in EUR
Spektar putovanja d.o.o.
ZAGREBACKA BANKA ZAGREB
IBAN HR1323600001500395457
SWIFT ZABA HR 2X