OBRAZAC ZA PRIJAVU – REGISTRATION

    1. PODACI O SUDIONIKU / PARTICIPANT DETAILS (presenting author):

    Molimo da za svakog sudionika ispunite zaseban formular / One form per active participant.

    *Prezime / Family name

    *Ime / First name

    Adresa prebivališta / Adress (private)

    *Zanimanje - Titula / Profession - Title

    *E-mail

    GSM / Mobile phone

    Tel. broj / Phone (inc. Country code)

    *Ustanova / Institution (Hospital, Clinic)

    *Adresa ustanove / Institution address

    *Grad, broj pošte / City, zip code

    *Država / Country

    2. KOTIZACIJA / REGISTRATION FEES:

    Molimo da označite sa X svoj izbor / Please signe with X your choice

    VRSTA KOTIZACIJE / CATEGORY

    Uplata do 30.06.2017.
    Before June 30, 2017

    Uplata nakon 01.07.2017.
    After July 01, 2017

    Članovi HLU / CLA members *

    850,00 HRK / 115 €

    A1

    1.150,00 HRK / 155 €

    A2

    Ostali sudionici / Other participants

    1.450,00 HRK / 195 €

    B1

    1.750,00 HRK / 235 €

    B2

    Osobe u pratnji / Accompanying persons

    850,00 HRK / 115 €

    C1

    1.150,00 HRK / 155 €

    C2

    3. IZBOR HOTELSKE USLUGE / HOTEL SERVICE CHOICE:

    Molimo da označite sa X svoj izbor / Please signe with X your choice

    USLUGA /SERVICE

    Cijene (po sobi po danu) / Prices (per room per day)

    Valamar Diamant Hotel 4* POREČ

    Smještaj / Accommodation

    Standard soba „single use“ – 1/1 (za jednu osobu) / Single room

    630 HRK (84 €)

    A1

    Standard soba „double use“ – 1/2 (za dvije osobe) / Double room *

    780 HRK (104 €) *

    A2

    *Ukoliko je Vaš izbor dvokrevetna soba, molimo navedite ime druge osobe u sobi, u protivnom će Vam biti naplaćena cijena jednokrevetne sobe. /
    If your choice is double room accommodation please specify the name of the person you will be sharing it with, otherwise you shall be charged for a “single use” room.

    Ime i prezime druge osobe / Family name and first name:

    Doplata za ručak / Supplement for lunch

    Buffet ručak / Buffet lunch

    Cijena (po osobi po danu) / Price (per person per day)

    75 HRK (10 €)

    Da / Yes

    Datum dolaska / Arrival date:

    Datum odlaska / Deparature date:

    Check in: 14:00 / Check out 10:00

    4. PLAĆANJE RAČUNA / PAYMENT OPTIONS

    BANKOVNA DOZNAKA / BANK TRANSFER DETAILS

    Da / Yes

    PLAĆANJE KREDITNOM KARTICOM / CREDIT CARD PAYMENTS

    Da / Yes

    Prihvaćam uvjete otkazivanja objavljene na službenim web stranicama kongresa: www.hlu.hr /
    I accept all terms and cancelation policy published on Congress web site: www.hlu.hr

    Da / Yes

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