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