Registration form

parkinson2019 - přihláška (en)

Title

First name*

Surname*

Institution*

Phone

E-mail*

I will attend the conference dinner on December 12, 2019

I will attend the lunch on December 13, 2019

Registration fee (incl. 21% VAT)*

1000 Kč - doctors – payment till December 9, 2019

1500 Kč - doctors - payment after December 9, 2019

Bez poplatku - medicine students, nurses and doctors of Department of Neurology, FNOL

Payment information

bank order

invoice

For payments in EUR:
Bank name: Komerční banka, a.s., pobočka Olomouc
Account name: Univerzita Palackého v Olomouci
IBAN: CZ0901000000191096330227
SWIFT code: KOMBCZPPxxx
Variable symbol: 999021115

For payments in CZK:
Bank name: Komerční banka, a.s., pobočka Olomouc
Account number: 19-1096330227/0100
Variable symbol: 999021115
Account name: Univerzita Palackého v Olomouci

Payment should be made by December 9, 2019; after this date please make the payment of the conference fee in cash or by card at the registration desk. Please mail a copy of your bank transfer order form to romana.sedlackova@upol.cz as a confirmation of payment. For a successful payment, it is necessary to include the variable symbol.

Payment confirmation

I need to issue payment confirmation (in case the conference fee is already paid)

parkinson2019 - fakturační údaje (en)

VAT number*

Institution*

Street, number*

Postal code*

City*

parkinson2019 - přihláška - závěr (en)

By submitting this registration form, you agree with the use of your personal data for the symposium purposes.

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Pitfalls and Complicationsin Movement Disorders Treatment

parkinson2019 - přihláška (en)

Pitfalls and Complications
in Movement Disorders Treatment