HOTEL 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:
 
HOTEL RESERVATION
 
Dubrovnik-President Hotel**** double - single use(150 EUR)
double (188 EUR)
Argosy Hotel*** double - single use (94 EUR)
double (120 EUR)
Number of persons
Arrival
Departure
No. of Nights
 
*Additional Remarks
 
NOTE: Please, fax also the signed Credit Card Authorization form (step 2).