APPLICATION FIBROMIX-2018

PARTICIPANT (full legal name of organisation)*

INN (Taxpayer Identification Number)      KPP (Tax Registration Reason Code)  

represented by (position, chief's name)*

acting on the basis*  

Legal address*

Mailing address*

Phone*        

Contact person*

REGISTER OUR PARTICIPATION IN THE CONFERENCE:
ATT! All fields are required!
Surname and name of the participant 1 *
Choose variant:
select from the drop-down list*
Position of participant*
E-mail*
Mobile phone*

Surname and name of the participant 2
Choose variant:
select from the drop-down list
Position of participant
E-mail
Mobile phone

Surname and name of the participant 3
Choose variant:
select from the drop-down list
Position of participant
E-mail 
Mobile phone

BOOK A ROOM IN HOTEL:*


SELECT HOTEL AND ROOM:
ATT! Check in time - 14.00. Check out time - 12.00.
Early check-in (from 08.00 till 14.00) & late check-out (from 12.00 till 18.00) is charged at additional 50% of one night's stay if apartment is available.
Early check-in (before 08.00) & late check-out (after 18.00) is charged at additional 100% of one night's stay if apartment is available.
Room (Price/night) Adults Arrival Departure

Place an ad in conference-hall:



Register our participation in additional excursion "Pearl Necklace of Saint Petersburg" 15.09.2018 (5,500 rubles):*




Type the characters you see in the picture*