PRIME and SMACD 2018 | Registration Form

Personal data
(Fields indicated as required have to be filled in.)

Mr / Ms

Academic degree / title

Name (required)

Surname (required)

Institution (required)

Address

City (required)

ZIP code

Country (required)

Mobile phone

VAT number

E-mail (required)

Registration

Fee

Early bird (until May 15)
Standard (May 16 - June 10)
Late (from June 11)

Participant

Students full registration - conference + workshop (IEEE member)
Students full registration - conference + workshop (Non-IEEE member)
Other full registration - conference + workshop (IEEE member)
Other full registration - conference + workshop (Non-IEEE member)
Workshop only registration
IEEE CASS Scholarship

Registration fee due EUR

Note

Full registration includes publication of 2 papers, access to PRIME and SMACD conferences, proceedings of both conferences, access to Company Fair, coffee breaks, lunches, welcome reception and conference dinner, and VAT.

Optional

Additional Conference Proceedings (pen-drive)

Quantity:

Total EUR

Additional tickets for accompanying persons

Welcome Reception

Quantity:

Social Dinner

Quantity:

Total EUR

Other information

IEEE member number

Submitted paper 1 (number)

Submitted paper 2 (number)

Paper(s) submitted to

PRIME
SMACD

Visa letter request

Yes
No

Additional information for visa letter (date of birth, passport number)

Dietary restrictions

Accommodation

Hotel

Room price per 1 night

single room
double room
1 person in a double room
triple room
quadruple room
apartment

Date of arrival . 2018

Date of departure . 2018

Nights total

Total EUR

Accommodation prices:
Hotel	single room	double room
Hotel Belvedere	78 EUR	86 EUR
Hotel Leonardo	175 EUR	175 EUR
Art Hotel Meda (July 1-4)	54 EUR	74 EUR

The room price includes one night in a single or double room, breakfast and VAT
Hotel assignment will be made on a first-come, first-serve basis.
Room reservations cannot be made without advance payment.
The hotel voucher will be mailed to you upon receipt of payment.

Cancellation policy
Cancellation date	Until May 31, 2018	After May 31, 2018
Registration	100% refund less an administration fee of EUR 150	N.A.
Accommodation	100% refund	N.A.

Cancellation request will be accepted only by e-mail sent to info@prime2018.org or info@smacd2018.org with a reference to PRIME/SMACD and your registration ID.

Payment

By credit card

Internet payment may be made after submitting your registration.
On-line credit card payments over the internet are secured by 3D SECURE.

Direct Bank Transfer

Bank: ČSOB, Na Moráni 3, 128 00 Prague 2, Czech Republic
Account Name: AMCA, spol. s r.o.
Account Number: 246357149/0300
IBAN: CZ08 0300 0000 0002 4635 7149
BIC: CEKOCZPP
Details of payment: Please enter the registration number you will receive in the e-mail confirmation of your registration
N.B. Please note that all direct bank transfer charges must be covered by the participant. Please forward a copy of your bank transfer order to the address of the secretariat.

Total due0 EUR

ANTISPAM PROTECTION

Type only the black letters below.

By submitting this form I agree to the use of my personal information by the company AMCA, spol. s r.o. in accordance with the Czech Personal Information Protection Act 101/2000.