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14 Mar 94
INET'94 CONFERENCE REGISTRATION TEMPLATE
Family Name:
First Name:
Prof__ Dr__ Mr__ Ms__
Internet Society Member:
Title:
Affiliation:
Street Address:
City:
State:
Postal Code:
Country:
Email:
Fax:
Telephone:
Preferred Badge Name:
Registered Accompanying Person(s):
Conference registration fee MUST accompany this form and must be
received before registration or accommodation can be processed. Keep a
copy of this form for your records. Print or type information. Use one form
per individual registration.
Return Completed form to:
VC CVUT
INET'94/JENC5
Conference Registration Office
Zikova 4
166 035 Praha 6
Czech Republic
Email:<register@earn.cvut.cz>
Fax: +42 22 431 0271
Tel: +42 23 32 2916
Registration Fees:
Before 1 May 94:
Internet Society Member US$ 425
Non-Member US$ 475 (includes automatic membership)
After 1 May 94:
Internet Society Member US$ 475
Non-Member US$ 525 (includes automatic membership)
On-site (after 6 June 94)
Internet Society Member US$ 525
Non-Member US$ 575 (includes automatic membership)
Accompanying Person US$ 125 (includes Opening Reception,
Gala Dinner and Cocktail)
Payment:
Registration: US$: _________
Hotel Deposit (1 night) US$: _________
Total: US$: _________
All payments must be in United States Dollars. Bank transfer, international
money orders and international credit cards (VISA, American Express and
Master Card) are acceptable. Personal checks are not acceptable.
Bank Transfer: Bank account No. 1412130287/0100, Komercni banka,
Dejvicka 52, Praha 6, Czech Republic, with your name
____VISA ____MasterCard ____American Express
Credit Card Number:
Expiration Date:
Name on Card:
Signature:
Special Needs:
Meals:
Other:
Hotel Reservations
Hotel reservations can be made by completing this form.
cut-off date: 30 MAY 94
________ Forum Hotel (US$ 153,-/single; US$ 168,-/double)
________ Panorama Hotel (US$ 125,-/single; US$ 142,-/double)
________ Union Hotel (US$ 95,-/single; US$ 112,-/double)
________ Patty Hotel (US$ 80,-/single; US$ 93,-/double)
________ ILF Hotel (US$ 50,-/single; US$ 65,-/double)
________ Kupa Hotel (US$ 30,-/single; US$ 40,-/double)
Hotel extras should be paid directly to the hotel reception.
Room Reservation Name ____________________
Sharing With: ____________________
Arrival Date: ___________/__________/1994
Departure Date: ___________/__________/1994
Please check one of the following:
___ l person ___ 2 persons, double beds ___ 2 persons, twin beds
___ Suites (extra cost)
Do you have a special accommodation request (e.g., no-smoking room,
disability or handicap)? _____________________________________
Accommodation Deposit:
Your room reservation can be guaranteed by either of the following methods:
1. Complete the Credit Card Authorization section of this form. The
INET'94/JENC5 Conference Registration Center can quarantee your room
with the hotel by your credit card. This is the easiest way to quarantee your
reservation.
2. Send one night's hotel fee along with the registration fee, if paying by
check.
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