GD'99  PAYMENT FORM   

Please, send the completed form 
      by e-mail to gd99@kam.ms.mff.cuni.cz (preferably)
      or by fax to (420)-2-7934120
      or hard copy to Anna Kotesovcova, Conforg s.r.o., 7. kvetna 959,
                      CZ-14900 Praha 4, Czech Republic

Note that you must also return a GD'99 REGISTRATION FORM to complete 
your registration.

Note that you have to arrange payment of the lodging deposit before
August 1, 1999, otherwise accommodation availability will not be guaranteed.

Registration fees can be paid after August 1 or on site, but late
(higher) fees would apply.

Lunches, lodging ballance and excursions may be paid on site at the same
price. 

Lodging may be paid in advance after we confirm the reservation. See the
ACCOMMODATION form.

  

Name: ________________

e-mail: ______________

Registration fee:
Regular     CZK 9000  _______
Student     CZK 5000  _______
Acc. person CZK 5000  _______

Lodging deposit:
Stirin castle CZK 3000
       (or US$ 100)   _______
Velke Popovice CZK 700
       (or US$ 30)    _______

Lunches     CZK 1200: _______

Excursions:
Jewish town CZK 900   _______
Konopiste   CZK 600   _______


Total payment:       ________  



Payment method:    ___ cheque in Czech crowns or US$, made to 
                       the order of CONFORG s.r.o. (send the cheque
                       to the address above)
                        
                   ___ money order in Czech crowns or US$, 
                       made to Komercni banka Praha 1, Prague,
                       Czech republic
                       account No 19-3318450267/0100
                       account name Conforg s.r.o.

                   ___ credit card (in this case fill in the details
                       below and send signed hard copy to the address
                       above - DO NOT SEND REQUESTED INFORAMATION
                       ABOUT YOUR CREDIT CARD BY E-MAIL!)


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                    GD'99 CREDIT CARD MAIL ORDER FORM

For credit card payments:

          __VISA      __Mastercard      ___JCB

(sorry no other cards accepted)
 

Card Number: ______________________  Expiry date:______________

Amount of payment: ________ CZK

To be paid to the order of CONFORG s.r.o. for GRAPH DRAWING '99.

Cardholder's Signature: _________________________________________________

Full Name as it appears on credit card: _______________________________


Credit card payments are processed in Czech crowns only.

Send a signed copy to 
   Anna Kotesovcova 
   Conforg s.r.o. 
   7. kvetna 959
   CZ-14900 Praha 4
   Czech Republic

 

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