REGISTRATION FORM

“EU International Co-operation Policy :
The Involvement of the Visually Impaired Movement”


20-22 October 2006

HOTEL CONFORTEL ALCALÁ NORTE
San Romualdo 30, 28037 Madrid




PLEASE COMPLETE AND RETURN ONE FORM FOR EACH PERSON REGISTERING TO TAKE PART IN THE CONFERENCE


FAMILY NAME:


FIRST NAME:


ORGANISATION:


REPRESENTATIVE: YES/NO


GUIDE: YES/NO


P.O. BOX / STREET ADDRESS:


POST CODE AND CITY OR STATE:


COUNTRY:


TELEPHONE:


FAX:


E-MAIL:



ACCOMMODATION ( BREAKFAST INCLUDED):


Arrival date:


Departure date:


Type of room: SINGLE / DOUBLE


I will be sharing a double room with:


Double Rate per night EURO 94,50 (VAT and breakfast included)
Single Rate per night EURO 86,67 (VAT and breakfast included)


SPECIAL DIETARY NEEDS:


VEGETARIAN: YES / NO


OTHER DIETARY NEEDS (PLEASE STATE):


OTHERS

I WILL TRAVEL WITH A GUIDE DOG: YES/NO


ANY OTHER COMMENTS OR REQUIREMENTS:




PLEASE RETURN THIS FORM BY FAX BEFORE 20TH SEPTEMBER 2006


CONTACT

INCENTIVES DEPARTMENT
Conference Secretariat
Tel: +34 91 323 78 14/ 91 323 25 23
Fax: +34 91 314 73 07
E-mail : rgaliano.viajes@once.es

Payment Details All payments must be made to VIAJES 2000 (ONCE travel agency) in EURO.

Payment has been made by:

_ My reservation is guaranteed with credit card: _VISA _EURO/MASTERCARD _AMEX

I agree that my credit card details will be forwarded to the appropriate hotel to guarantee the booking and that the hotel may debit my card in the event of any cancellation fees applicable.

Card Holder:


Card No: ____________________________

Expiry Date: _________________________

CCV security code*: _________________________

I have arranged a bank transfer for payment equivalent to two nights' stay: free of charge to the recipient to VIAJES 2000




* American Express: 4 digits in front of card.
VISA and MasterCard: 3 digits at back of card.


BANK TRANSFER DETAILS:

Bankinter: 0128/9400/22/0100024721
Codigo Iban: ES39/0128/9400/2201/0002/4721
Swift: BKBKESMM

Please send copy of the bank transfer by fax.

Having signed below I confirm that I have read and agreed with the cancellation and payment conditions indicated above.

Date ___________________________________

Name _________________________________________________________________

Signature ______________________________________________________________


CANCELLATION AND CHANGE POLICY

Please inform VIAJES 2000 in writing and NOT the hotel about any changes regarding arrival and departure dates. For cancellations before 30th September 2006, no cancellation fees will be charged.


VIAJES 2000 regrets that the hotel deposit cannot be refunded for hotel cancellations after 1st October 2006.


Back to contents