(Upon completion send by e-mail to ASA: CBMTS@asanltr.com and Croatian Organizing Committee: email@example.com and firstname.lastname@example.org or fax : ASA at 1-410-638-9481 and Croatian Organizing Committee: 00385-1-378-6700 or mail : Croatian Organizing Committee, MOD M-1, Defense Policy and Planning Depart., Illica 256b, HR-10000, Zagreb, Croatia and: ASA, PO Box 1144, Aberdeen, Maryland 21001 USA)
Registration Form for:
CBMTS-Industry IV “The Third World Congress on Chemical, Biological, Radiological Terrorism”
Dubrovnik, Croatia 18-23 September 2005
with a special Workshop 17/18 September 2005
- Family Name: __________________________________________
- First Name(s): ___________________________________________________
- Title/Profession/Organization: _____________________________________
- Best Postal Mailing Address:_______________________________________
- Phone, Fax, E-mail addresses: _____________________________________ ________________________________________________________________
- Abstract Title:___________________________________________________
- Abstract has been sent or will be sent: (give date) ____________________
- Individual Registration Fees: all fees are in Euros (€)
• Gov/Academia registration fee: to 1 June: €685; after 31 May €760
• Industry registration fee: to 1 June: €785; after 31 May €860
•• Above price includes transportation to and from Dubrovnik Airport and most meals, Welcome Party, Symposium Dinner and special events.
•• Note: Send registration payment to either ASA-CBMTS or CBMTS-Croatia. CBMTS prefers use of Credit cards. Credit card Companies will convert currencies. Cards include Visa, Master Card, American Express and Diner’s Club. The ASA- CBMTS bank account number for electronic transfer will be supplied upon request.
- Hotel Information/Fees: Fees are in Euros, €. All hotels include breakfast.
• Excelsior Hotel: (conference venue), single no sea view, € 132 single, sea view, € 168; double, sea view, € 210
• Lero Hotel: (limited number of rooms); € 80 and double € 90
• Park Hotel: single € 106 and double € 122
•• Please note: CBMTS requires Hotel Deposit € 100. or Registration Fee. When Registration Fee is paid, hotel deposit is assured. If there is a no show, the hotel deposit of €100. will be subtracted from the Registration Fee prior to consideration for registration fee reimbursement.
- Accommodation Request: Hotel preference/dates _______________________
- Airline and Arrival/Departure dates and times for Dubrovnik. Please give flight number in order for you to be picked up at airport.
- Accompanied person fees for lunches, dinners, Welcome Party and Symposium Dinner: (will be supplied)
- Terms of Payment for Registration Fee and/or Hotel Deposit:
Credit card number, expiration date and cardmember name: _______________________________________________________________
b. Electronic transfer or Check? ______________
Updated by Evan, 23 May 2005
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