Please print, fill up and sign this registration form and send it by post to:
ZEGG - ICSA German Office
Rosa-Luxemburg-Str. 89
D – 14806 Belzig
Germany
If you want to stay informed about ICSA 2001, please send an e-mail to icsa@zegg.de - we will put you on our mailing list.
REGISTRATION FORM
Please return by March 31, 2001
Please print or use a typewriter
Please use one registration form per participant
Status:
....... Full Participant
....... Student/Community Delegate
Title:
....... Prof.
....... Dr.
....... Mr.
....... Mrs.
Surname:
First Name:
Institution:
Mailing Address:
ZIP - Code / City:
Country:
Phone:
Fax:
E-mail:
Participant
....... € 185 Euro until March 31, 2001
....... € 205 Euro after March 31, 2001
SStudent/Community Delegate
....... € 175 Euro
I will attend the Post Conference Tour from June, 29 to July, 1, 2001
The fee includes meals, trip and one accomodation in another community.
....... yes / no € 115 Euro
I will stay in ZEGG June 28, 2001(rest and recreation, presentation of ZEGG)
....... yes / no € 20 Euro
Please notice: The overnight stays in Belzig are not included.
You are very welcome to stay for the International Gathering of Communities.
Further information will be given after February 2001.
....... Please tick if you are interested.
Arrival Date:
Departure:
In order to guarantee the reservation in nearby hotels, a deposit of 50 Euro per person is required and must be remitted in advance. After receipt of this amount the hotel reservation will be confirmed and a hotel deposit voucher will be sent to you. The value of the voucher will be deducted from your final hotel bill. All rates include breakfast.
Price per person per night:
....... tent/dormitory € 15 Euro
....... 3-8 persons room € 20 Euro
ZEGG hotel without private bathroom
....... single: € 32 Euro
....... double: € 28 Euro
nearby hotel (private bathroom, shuttle to ZEGG)
....... single: € 42 Euro
....... double: € 38 Euro
Total amount?
€ ................ Conference Fee
+ € .............. Post Conference Tour
+ € .............. deposit
= € .............. Total amount
..... by bank transfer to ZEGG GmbH, Raiffeisenbank Belzig, Germany,
Account No. 10 40 52 625, Bank Code (BLZ): 160 620 48
Please state "ICSA 2001" and the full name of the participant on the
bank transfer.
..... Visa Credit card
This will add an additional fee of € 10 to the total amount.
Card number:
Date of Expiration:
Name Card Holder:
....... by sending Eurocheques to ZEGG-ICSA office
(max. amount per cheque: € 200. Each cheque complete with signature and
bank card number.)
Please check carefully: any bank charges will be borne by participants.
Cancellation should be made by writing to the conference office. Please note that refunds will only be made after the completion of the conference.
*Before February, 28, 2001 total amount minus 30 € minus bank charges.
*Until May, 25, 2001, 50 % of the amount will be refunded.
*After May, 25, 2001 no refunds will be made.
By sending in this registration form I acknowledge that I commit myself to the immediate payment of the full conference fee. I have taken notice of the cancellation terms on this form.
Date:
Signature: