Conference Registration Form

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1 File: HydroEco2006_registration_conference_13_Feb_2006.pdf, 13 February 2006 Conference Registration Form REGISTRATION FORM International Multidisciplinary M Conference on Hydrology and Ecology: The Groundwater/Ecology Connection Karlovy Vary (Carlsbad), Czech Republic September 2006 Please return (mail or fax) the completed form to: HydroEco2006 Conference c/o ITC Travel & Conference s.r.o. Attn. Ms Radka BUDSKÁ (until May 2006) and Ms Lucie MUSILOVÁ (as of May 2006) Konevova 41 CZ Prague 3 Czech Republic Fax: hydroeco2006@itctravel.cz Please complete this form (type or print) and return preferably before 31 May Note that 31 May 2006 is also the deadline for the receipt of the early registration fee. The form can be mailed or faxed to the above address. Retain a copy of the completed form for your personal file. Contact Address Participant Title (Ms / Mr / Prof / Dr / Dipl-Ing / Ing / Ir / Drs / MSc /.) Surname (family name) First Name (given name) Organization/Institute Mailing Address (street, PO Box) Town/City Postal/Zip Code Country Telephone Fax Address

2 Reduced-rate conference fee Students, and participants from the Czech Republic, Slovakia and other former eastern European" countries. Please send your enquiries and applications (with a brief motivation and, where relevant, a student ID) to the attention of the Conference Secretariat (address above). You may proceed with registration (sending the Registration Form and arranging the fee payment) only after you have received an approval for the reduced conference fee. Yes, I have received from the organizers the permission to pay the reduced-rate conference fee Items are listed in chronological order, as they may be relevant for you: Pre-Conference Stay (Hotel Accommodation) in Prague (optional) Coach Transfer from Prague to Karlovy Vary (Carlsbad) (optional) Conference A Conference Registration Fee B Conference, Accompanying-persons Program C Conference, Hotel Accommodation in Karlovy Vary (Carlsbad) Coach Transfer Karlovy Vary (Carlsbad) to Prague (optional) Post-Conference Stay (Hotel Accommodation ) in Prague (optional) ================================================================= Pre-Conference Stay in Prague (optional) ( ( Hotel Accommodation in Prague Arrival Departure Sharing double room with: Dates:.../SEPT/ /SEPT/2006 Mr/Ms Hotel Single Double Total Nights Total for Accommodation Maria Falkensteiner **** Address:Opletalova 21, Prague 1 Harmony*** Address:Na Porici 31, Prague 1 Digitals*** Address: Na Petynce 106,Prague 6 EUR 128 EUR nts. EUR... EUR 99 EUR nts. EUR... EUR 67 EUR nts. EUR... Economy type accommodation EUR 55 EUR nts. EUR... Total for Accommodation: EUR... rates as above are quoted per room and night and include breakfast and taxes. Due to a limited availability of hotel rooms in each hotel requests will be handled on first-come-firstserved basis. Advance payment for hotel accommodation will be required.

3 Coach Transfer from Prague to Karlovy Vary (Carlsbad) (optional) ( The HydroEco2006 transfer desk will be open in the Arrival Hall of the Terminal North 1 (non-schengen terminal) of the Prague International Airport just off the customs area on Sunday, September 10, between 12:00 and 17:30 hours. Check the seat availability on the nearest possible transfer with the staff at the desk. If you do not book this transfer in advance here, on-site requests will be possible but will be subject to availability and may not be honoured. Two options are available: Sunday, September 10, 2006, BUS 1, EUR 23 per person on this transfer Departure 12:00 from Harmony Hotel Praha Departure 12:10 from Maria Falkensteiner Hotel Praha Departure 12:25 from Digitals Hotel Praha Departure 12:45 from Prague International Airport Arrival at Hotel Pupp in Karlovy Vary at around 15:00 Sunday, September 10, 2006, BUS 2, EUR 23 per person on this transfer Departure 16:00 from Harmony Hotel Praha Departure 16:10 from Maria Falkensteiner Hotel Praha Departure 16:25 from Digitals Hotel Praha Departure 16:45 from Prague International Airport Arrival at Hotel Pupp in Karlovy Vary at around 19:00 Number of persons: Total amount bus transfer to be paid: EUR Conference A Conference Registration Fee (tick one box) Regular Conference Registration Fee. Includes prepublished proceedings, refreshments, lunches during four conference days, the Welcome Drink (Sunday,. 10 September) and Conference Dinner (Tuesday, 12 September). Before 31 May 2006 EUR 510 After 31 May 2006 EUR 620 or Reduced Student Registration Fee. Includes prepublished proceedings, refreshments, lunches during four conference days, and the Welcome Drink (Sunday, 10 September). Does not include the Conference Dinner (Tuesday, 12 September). Before 31 May 2006 EUR 320 After 31 May 2006 to pay the regular registration fee (see above) or Reduced Conference Fee for Participants from Economically Weak Countries. Includes prepublished proceedings, refreshments, lunches during four conference days, Welcome Drink (Sunday, 10 September) and Conference Dinner (Tuesday, 12 September). Before 31 May 2006 EUR After 31 May 2006 EUR B Conference, Accompanying-persons Program Includes the Welcome Drink (Sunday, 10 September), and the Conference Dinner (Tuesday, 12 September). Before 31 May 2006 EUR 80 After 31 May 2006 EUR 97 Number of persons: B Total amount accompanying persons: EUR

4 C Hotel Accommodation in Karlovy Vary (Carlsbad) ( Arrival Departure Sharing double room with: Dates:.../SEPT/ /SEPT/2006 Mr/Ms Hotel Single Double Total Nights Total for Accommodation Grandhotel Pupp ***** EUR 165 EUR nts. EUR... Parkhotel Pupp **** EUR 110 EUR nts. EUR... Krásná Královna **** EUR 90 EUR nts. EUR... Slovan *** EUR 58 EUR nts. EUR... Boston *** EUR 68 EUR nts. EUR... Palatin *** EUR 70 EUR nts. EUR... Amadeus *** EUR 60 EUR nts. EUR... Marttel *** EUR 55 EUR nts. EUR... C Total for Accommodation: EUR... rates as above are quoted per room and night and include breakfast and taxes. Due to a limited availability of hotel rooms in each hotel requests will be handled on first-come-firstserved basis. Advance payment for hotel accommodation will be required. Coach Transfer from Karlovy Vary (Carlsbad) to Prague (optional) ( On-site requests during the first conference day, Monday, 11 September will be possible. Coach transfer bookings made after September 11 will be subject to availability and may not be honoured. Two options are available: Thursday, September 14, 2006, BUS 3, EUR 23 per person on this transfer 17:40 Departure from Hotel Pupp Karlovy Vary Arrival at Prague International Airport at around 19:30 Drop-off at Digitals Hotel Praha at 19:50 Drop-off at Harmony Hotel Praha at 20:10 Drop-off at Maria Falkensteiner Hotel Praha at 20:20 Friday, September 15, 2006, BUS 4, EUR 23 per person on this transfer 8:30 Departure from Hotel Pupp Karlovy Vary Arrival at Prague International Airport at around 10:30 Drop-off at Digitals Hotel Praha at 10:45 Drop-off at Harmony Hotel Praha at 11:00 Drop-off at Maria Falkensteiner Hotel Praha at 11:10 Number of persons: Total amount bus transfer to be paid: EUR

5 Post-Conference Stay in Prague (optional) ( ( Hotel Accommodation in Prague Arrival Departure Sharing double room with: Dates:.../SEPT/ /SEPT/2006 Mr/Ms Hotel Single Double Total Nights Total for Accommodation Maria Falkensteiner **** Address:Opletalova 21, Prague 1 Harmony*** Address:Na Porici 31, Prague 1 Digitals*** Address: Na Petynce 106,Prague 6 EUR 128 EUR nts. EUR... EUR 99 EUR nts. EUR... EUR 67 EUR nts. EUR... Economy type accommodation EUR 55 EUR nts. EUR... Total for Accommodation: EUR... rates as above are quoted per room and night and include breakfast and taxes. Due to a limited availability of hotel rooms in each hotel requests will be handled on first-come-firstserved basis. Advance payment for hotel accommodation will be required. ================================================================= GRAND TOTAL + + A +B +C + + = EUR

6 Terms of Payment I. International Money Order / Bank Transfer: Account name/beneficiary: ITC Travel&Conference Address of the beneficiary: Konevova 41 CZ Praha 3 Czech Republic Bank/address: Details of payment: CSOB (Ceskoslovenská obchodní banka) Václavské námestí 32 CZ Praha 1 Czech Republic /hydroeco/ here your name a) Payments effected in EUR only: I will pay by bank transfer the total amount of EUR to: Account number: /0300 Account number in IBAN format: CZ SWIFT: CEKOCZPP Please note that bank charges must be fully covered by the participant. Your bank will provide the information about applicable bank charges. b) (for Czech participants only) Tuzemské platby v K: Dispozice pro platby v K (vztahuje se na tuzemské úastníky). Zaplatím pevodem ástku K ve prospch útu.: / 0300 Do poznámky/zprávy pro píjemce prosíme uvést: /hydroeco/ jméno úastníka II. Cheques: I enclose a cheque for the total amount of EUR made payable to ITC Travel&Conference, Konevova 41, CZ Praha 3, Czech Republic III. Credit Card Payments: Charge my credit card for the total amount of EUR Please tick one: VISA MasterCard/EuroCard Diners American Express Credit Card Number: Expiry Date: Card holder name (as printed on the card): Signature: Date:

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