3rd Genomic Instability Workshop
20th/23rd November 2010
Congress venue: IFOM-IEO-CAMPUS – Via Adamello 16 – 20139 Milan (Italy)
TRAVEL/HOTEL FORM
Please fill out this form to register and send it to CQ Travel by post or by fax: +39-02-43911650
Surname
Name
Address
Zip code
Town
Country
Telephone
Fax
E-mail
Partita IVA or Codice fiscale (only for Italian participants)
FLIGHT BOOKING:
Departure from: _______________________
Flight: __________
Departure time: ____________
Departure from: Milano
Flight: __________
Departure time: ____________
Preferred airline: _____________________
Frequent flyer card number: ________________________
FLIGHT CANCELLATIONS
Penalties for flight cancellations or modifications will be given individually, as they vary according to the applied airfare.
HOTEL BOOKING:
Prices are per day, per room, including breakfast and taxes. Please indicate the required accommodation.
Hotel Lloyd, C.so Porta Romana 48
Hotel Major, Viale Isonzo 2
Hotel Una Mediterraneo, Via L. Muratori 14
CAT.
DOUBLE room
DOUBLE SGL/USE room
4
4
4
4
 € 110,00
 € 140,00
 € 84,00
 € 120,00
 € 100,00
 € 120,00
 € 84,00 (valid for 20 and 21 november)
 € 120,00 (valid for 22 november)
Date of arrival: ___________ Date of departure:_____________ Number of nights:____ TOTAL: €
FOR DOUBLE ROOMS, PLEASE INDICATE THE NAME OF THE SECOND PERSON (we do not arrange any coupling for the hotel
accommodation) __________________________________________________
HOTEL CANCELLATIONS
There will be a penalty of one night cost for cancellation of the hotel room from the 3rd September to the 12th November 2010.
Cancellations from13th November will be charged for the entire period. Cancellations must be made in writing to congress@cqtravel.com.
DEADLINE: 2nd September 2010
Surname
Name
TERMS OF PAYMENT:
CONFIRMATION
A written confirmation by email will be sent upon receipt of the payment.
PAYMENT
Payments can be made in EUROS by credit card, cheque or bank transfer through CQ Travel agency.
CHEQUE made out to :
CQ Travel srl – Via Pagliano 37 – 20149 Milano – Italy
BANK TRANSFER to:
Bank codes:
CQ Travel srl c/o Banca Intesa San Paolo
IBAN IT27N 03069 09568 068142300160 SWIFT BCITITMMXXX
CREDIT CARDS:
 Visa
 Mastercard
 American Express
N° _________________________________________________ Expiry date __________________________________
Total amount authorized Euros______________
Card’s holder (block letters)
Card’s holder signature
Modifications to hotel reservations will be accepted only by fax to CQ Travel Srl (+39.02.43911650) or by email to: congress@cqtravel.com. Requests over the phone WILL BE NOT taken into consideration.
Date ___________________________________
Signature _________________________________