(Upon completion send by e-mail to ASA: CBMTS@asanltr.com and Croatian Organizing Committee: slavko.bokan@morh.hr and zvonko.orehovec@morh.hr 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

  1. Family Name: __________________________________________
  2. First Name(s): ___________________________________________________
  3. Title/Profession/Organization: _____________________________________
  4. Best Postal Mailing Address:_______________________________________
  5. Phone, Fax, E-mail addresses: _____________________________________ ________________________________________________________________
  6. Abstract Title:___________________________________________________
  7. Abstract has been sent or will be sent: (give date) ____________________
  8. 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.
  9. 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.
  10. Accommodation Request: Hotel preference/dates _______________________
  11. Airline and Arrival/Departure dates and times for Dubrovnik. Please give flight number in order for you to be picked up at airport.
  12. Accompanied person fees for lunches, dinners, Welcome Party and Symposium Dinner: (will be supplied)
  13. Terms of Payment for Registration Fee and/or Hotel Deposit:
    a.     Credit card number, expiration date and cardmember name: _______________________________________________________________
    b. Electronic transfer or Check? ______________

 

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Updated by Evan, 23 May 2005

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