DORMITORY RESERVATION FORM

(Fields marked with * are optional)
 
International course and conference MIND AND BRAIN V: Physics and the Brain
September 17-23, 2006, Dubrovnik, Croatia
 
GUEST – MAILING ADDRESS
 
Title/Degree:
First name:

Family name:

Institution:
Street address:
Postcode/Zip code:
City:
Country:
Phone:
Fax:
E-mail:
E-mail confirmation:
 
DORMITORY RESERVATION
 

Room type

single (35 EUR per person/night)
double (25 EUR per person/night)

*Willing to share the room with:
Date of birth (dd/mm/yyyy):
Sex: Female Male
Arrival
Departure
No. of Nights
 
*Additional Remarks
.
NOTE:
Dormitory reservation will be confirmed and guaranteed for the participants who pre-register for the MIND AND BRAIN V and send a proof of the course and conference registration fee payment by fax or email.