ES-PCRsince 22,06.2007since 22,06.2007since 22,06.2007since 22,06.2007
European Society of Pediatric Clinical Research
Europäische Gesellschaft fur klinische pädiatrische Forschung
formerly known as Pediatric Research of Central European Countries
Please return the form until May 31st
, 2011
Daniela Kodytkova
Children Oncology Department
Cernopolni 9, Brno, Czech Republic
E-mail : dkodytkova@fnbrno.cz
Fax: +42 5 32 23 4614
Registration Form
20th Meeting of ES-PCR
Jule 1st, 2011, Brno
Family Name:……………………………………..First Name:………………..…………..Title:…………....
Institution:…………………………………………….……………………...…………………………………..
Address:…………………………….……………………………………………………………………………
Zip Code/City, Town/Country:…………………………………….…………………………………………...
Phone:………………………………………………….Fax:……………………….…………………………..
Email:…………………………………………………………………………………………………………….
Hotel Reservation (National Health Sciences Centre (NCONZO) Vinarska street No 6) :
Room yea no
(The room rate per night is € 30,00 including all meals and breakfast.)
Hotel reservation June 30- July 1 yes no
Hotel reservation June 30- July 2 yes no
Hotel reservation July 1- July 2 yes no
Social Event (Johan Gregor Mendel Augustinian Monastery) on Friday, Jule 1st, 2011
yes no
Payment for hotel accommodation (€ 30,00/night, by bank draft ) :
Bank: 3503770297 / 0100
IBAN: CZ78 0100 0000 0035 0377 0297
SWIFT : KOMBCZPPXXX
after June 8th
payment at registration only, no Credit Card payment possible :
……………………….. ………………………………………….
Date Signature