„GENETIC RESOURCES CONSERVATION - SCIENTIFIC AND SOCIAL CHALLENGES”
The Kostrzyca Forest Gene Bank, 25th June 2015
INTERNATIONAL SCIENTIFIC CONFERENCE
CONFERENCE REGISTRATION FORM
First name and surname
Academic or professional title
Post
Institution
Address for correspondence
Institution
Street name and number
Postal code
Town / City
Telephone number (with
country and area/city code)
E-mail
Additional comments
and information
for the organizers
The registration fee:
The participation cost is 450,00 PLN
The fee includes:
 Admission to all scientific sessions;
 Conference materials (abstracts and full texts of papers in a book format);
 Coffee service and lunch;
 Simultaneous interpreting at conference.
The fee does not include hotel services (accommodation, breakfast, supper).
The fee should be paid into the account number:
Bank Gospodarki Żywnościowej SA
IBAN: PL 78 2030 0045 1110 0000 0082 5820
SWIFT: GOPZPLPW
with a note: „Conference 25.06.2015 r., first name and surname”.
The Kostrzyca Forest Gene Bank
Miłków 300
58 - 535 Miłków
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„GENETIC RESOURCES CONSERVATION - SCIENTIFIC AND SOCIAL CHALLENGES”
The Kostrzyca Forest Gene Bank, 25th June 2015
A bill / invoice can be send by post or you can receive it in person during the conference.
Institution / personal invoice information:
Name / First name and surname:
Address:
Tax Identification Number:
 Delivery by post*
 Collection in person*
*Please mark the relevant box
Accommodation: Hotel „Artus”, ul. Wilcza 9, Karpacz. www.hotelartus.pl
Double room: 120,00 PLN per person per night (with breakfast)
Single room: 160,00 PLN per person per night (with breakfast)
Accommodation booking - please tick (X) the relevant option
24/25 June 2015:
Single room ……….
Double room ………
25/26 June 2015:
Single room ……….
Double room ………
Special dietary needs: ………………………….………………………………………………………………
Place and date
Signature
……………………………
……………………………
This application is an evidence of a contract. Resignation from participation in the conference is
possible only through a resignation declaration sent by e-mail, fax or registered letter to the
Organizer’s address till 20 May 2015.
Failure to cancel the participation till 20 May 2015 will result in 100% payment being charged.
I accept these participation conditions and agree to pay participation costs according to the number
of hotel nights and meals.
...............................................................................
Signature
Please send the application form by 31 March 2015 to the address: The Kostrzyca Forest Gene
Bank, Miłków 300, 58-535 Miłków or via e-mail message to the following address:
biuro@lbg.lasy.gov.pl
Deadline for payment of registration fee: 20 May 2015.
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