Registration: Olomoucké neuroimunologické sympozium

Registration form

ms2019 - přihláška (en)

Title

First name*

Surname*

Institution*

E-mail*

Phone

I will attend the conference dinner

I will attend the conference dinner on October 3, 2019

I will attend the lunch

I will attend the lunch on October 4, 2019

Registration fee (incl. 21% VAT)*

500 Kč - doctors (university employees) – payment till do September 9, 2019

700 Kč - doctors (university employees) - payment after do September 9, 2019

free – medicine students and nurses

Payment information

bank order

invoice

I do not require payment confirmation

For payments in EUR:
Bank name: Komerční banka, a.s., pobočka Olomouc
Account name: Univerzita Palackého v Olomouci
IBAN: CZ0901000000191096330227
SWIFT code: KOMBCZPPxxx
Variable symbol: 999021114

For payments in CZK:
Bank name: Komerční banka, a.s., pobočka Olomouc
Account number: 19-1096330227/0100
Variable symbol: 999021114
Account name: Univerzita Palackého v Olomouci

Payment should be made by September 20, 2019; after this date please make the payment of the conference fee in cash or by card at the registration desk. Please mail a copy of your bank transfer order form to romana.sedlackova@upol.cz as a confirmation of payment. For a successful payment, it is necessary to include the variable symbol.

Payment confirmation

I need to issue payment confirmation (in case the conference fee is already paid)

ms2019 - fakturační údaje (en)

VAT number*

Institution*

Street, number*

Postal code*

City*

ms2019 - přihláška - závěr (en)

Don't fill this field!

15th Olomouc Neuroimmunology Symposiumwith International Participation

Registration form

ms2019 - přihláška (en)

15^th Olomouc Neuroimmunology Symposium
with International Participation