Title: Performance Review Committee
Author: ŘLP ČR s.p.
Last saved by: Dan
Company: Smetanovo nábřeží 4/334

BOOKING FORM – EPG Prague 2004 Conference - May 18 – 23, 2004
Accommodation at the Charles University Hostel Jinonice 
U Kříže 8, Prague 5 – Jinonice, Czech Republic

DEADLINE FOR BOOKING: April 10, 2004
TO BE FAXED TO: (+420) 267 310 503 OR TO BE SENT ATTACHED TO ACTIONM@CUNI.CZ 
or mailed to: Action M Agency, Vrsovicka 68, 101 00 Praha 10, Czech Republic

SURNAME:………….............................................................FIRST NAME:……......................................................

TITLE: Mr./Mrs./Ms./Dr./Prof. …………………ACCOMPANYING PERSON:…………………………….……….………………

TELEPHONE NO:  ..........................................................FAX NO: ....................................................….….…………

E-MAIL:   ....................................................................... TOTAL NO. OF NIGHTS REQUIRED:.............................

ARRIVAL (TIME):  ...........................................................DEPARTURE DATE: ...............................................……

ARRIVAL TIME (CHECK-IN from 14.00)…………………………DEPARTURE TIME (CHECK-OUTuntil12.00)……………...…

   PAYMENT – Charles University Hostel Jinonice
Payment by credit CARD | | Payment by BANK TRANSFER
ACCOMMODATION | | | yes | | no
| single room:    880 CZK  x _____nights = | | | Payment to be sent to the Czech Republic, Komercni  Banka Praha 10, Milena Zeithamlova - Action M Agency, SWIFT: KOMB CZ PP, account CZK No. 221442101/Bank Code 0100. Please make sure that the bank transfer is made net of all bank charges and commissions.
| Double room: 1300 CZK  x _____nights = | | |
TOTAL:		                               CZK | | |
CREDIT CARD DETAILS | | name of THE PAYER:
| | name of the bank:
| VISA* | | MASTERCARD/EUROCARD* | | ACCOUNT NUMBER:
| AMEX | | JCB | | DINERS CLUB | | date of payment:
number: | | Cancellation Policy

•	cancellation received 1 month before arrival:	no charges
•	cancellation received 14 days  before arrival:  	one night room charge
•	cancellation received less than 5 days  or a “no show”: full booking charges

P R I N T
&
 SEND

Thank you

LAST 3 DIGITS: 
(on the signature strip - the reverse side)

EXPIRE: | | | | | |
Name on CC: | |
I, the undersigned, authorise the Action M Agency to charge to my credit card the total amount of | ______________CZK | |
Your signature: | |