Textové pole: Lékař 2 Doctor Email: lekar2doctor@gmail.com

                                         Registration Form

Course Date: Tuesday 29^th October 2013

Venue: LF1, Prague

Name


Address (UK and CZ)




Email


Phone number


University


Year of study


Dietary Requirements

(Vegan, Vegetarian, Meat, Chicken, Pork, Fish/Seafood)


Allergies


Return of this form to the email address below will reserve you a place on the course.  This is a
contract between you and Lekar 2 Doctor in association with Charles University, LF1.Cuni.cz.   It
is non-refundable. The course fee (£50/€60/1500CZ) will be collected on the day.

A confirmation email will be sent on receipt of the registration form.

Please email the form to lekar2doctor@gmail.com