REGISTRATION FORM

MOLEC XVII, European Conference on Dynamics of Molecular Systems
August 23-28, 2008, St. Petersburg, Russia

This form should be completed, signed, and returned to Dr. Alexei Podlaskin, Theasurer MOLEC XVII, by e-mail molec17@mail.ioffe.ru as an attached file, or by FAX Nr. 007(812)2971017 before June 9, 2008 with the note                         "To the MOLEC-17". 
General Information	   
Title:		Mr
		Mrs		Ms		Dr		Professor

          
First name:		Middle Initials:		Family Name:  		
                                        	
Affiliation:		

Postal Address:		

E-mail:		FAX:		Tel.		

Name of accompanying persons: (an age if under 16)

I chose accommodation in a double room below and would like to share the room with:

Special requirements:  Please give details of any special requirements and/or disability, diet, medical conditions, etc. for you or for accompanying person(s)

Please  indicate expected arrival time & date:		
  
and expected departure time & date: 		

Please complete the form below by indicating your choice in the boxes and entering your payment in the columns. All fees include VAT. 
Conference registration fee includes running costs of the Conference, visa support, transportation from the airport to the Conference Residence, Welcome party, Banquet, delegate pack including book of abstracts, but not Accommodation. 
The Accommodation covers six nights stay in the hotel from the evening August 23 till the morning August 29 and includes all meals.   

Conference registration fee	Payment	Accommodation 
(per person)	Payment	
Standard: by June 9, 2008

Regular participant	
€ 300	

Accompanying person
ppersonRegular Participant	
€ 100	

Student
ppersonRegular Participant	
€ 100	

After June 9, 2008

Regular participant	
€ 350	

Accompanying person Regular Participant	
€ 350	

Student
ppersonRegular Participant	
€ 150	

	

	Conference Residence

Single room 	

6 days @ € 90 per day = € 540† 

Double room	

6 days @ € 65 per day = € 390† 

Hotel Ekaterina
Double room	

6 days @ € 75 per day = € 450† 

	
		TOTAL PAYMENT		
† Adjust if not attending the whole conference
Additional nights at the Prince Kochubey Palace before and/or after the symposium can be arranged by including to the above form. The price is: single room - € 65/night, double room - € 80/night, breakfast included.
The payment free of all banking and postal charges should be made in EURO. On a bank order, the abbreviation MOLEC-17 and the name(s) of participant(s) and accompanying person(s) must be specified. Payment should be made to:  Company Business Visit, Ltd.:
Bank account
Bank VEFK 
Correspondent Bank: Deutsche Bank AG 
SWIFT: DEUTDEFF 
Beneficiary Bank: EEFC Bank Plc., 
SWIFT: PETRRU2P 
Account No: 100 9497918 1000 
Beneficiary: "Company Business Visit", 
Ltd Account No 40702978207119000013
The conference registration will open at 15-00 on Saturday August 23, 2008.  The conference will close after breakfast on Friday August 29, 2008.
Signature:		Date:		
		
No reservation for accommodation, meals, or social events will be made if payment is not received. All registrations will be acknowledged. If an acknowledgement is not received within 15 days, please contact   molec17@mail.ioffe.ru. Cancellation received before August 23, 2008 will be subject of a bank charge of 3%.  After August 23, 2008, no refund is possible, due to the commitments with the hotel and other services.