ACCOMMODATION FORM - Geyseco
ACCOMMODATION FORM - Geyseco
ACCOMMODATION FORM - Geyseco
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JUNE 4-7<br />
ESGAR 2013 European<br />
BARCELONA<br />
SPAIN<br />
Society<br />
of Gastrointestinal<br />
and Abdominal<br />
Radiology<br />
<strong>ACCOMMODATION</strong> <strong>FORM</strong><br />
Online accommodation at: www.geyseco.es/esgar2013<br />
If you are unable to make your booking online, please complete this form and return it, with full payment, as indicated on the form.<br />
Each registrant must complete a separate form.<br />
All prices are quoted in Euros and include V.A.T.<br />
STEP 1: PERSONAL DETAILS<br />
Title (Prof/Dr/Mr/Mrs/Other)<br />
STEP 3: <strong>ACCOMMODATION</strong> REQUEST<br />
Indicate accommodation preferences form 1 to 5.<br />
First Name<br />
Last Name<br />
Preference Hotel Name<br />
Double<br />
Room<br />
Single<br />
Room<br />
Afiliation<br />
Organization<br />
Address<br />
City<br />
State<br />
Country<br />
Phone<br />
Fax<br />
Email<br />
Postcode<br />
Full Hotel Rey Juan Carlos I ***** q203 € q187 €<br />
Full Hotel NH Constanza **** q184 € q165 €<br />
Full Abba Garden Hotel **** q152 € q132 €<br />
Husa Illa Hotel **** q160 € q139 €<br />
Full Hotel AC Victoria Suites **** q212 € q185 €<br />
Hotel Senator Barcelona **** q122 € q98 €<br />
Hotel NH Les Corts *** q110 € q90 €<br />
In compliance with the Organic Law on Protection of Personal Data 15/99 of 13<br />
December, we inform you that your personal data will be stored on a file owned by<br />
Grupo <strong>Geyseco</strong> S.L. to be used for the above described purposes. You may exercise<br />
your right of access, rectification, cancellation and opposition at the following<br />
address: datos@geyseco.es<br />
STEP 2: INVOICE REQUEST<br />
From 01 November 2012 a TOURIST TAX will be applied on hotel accommodation in Barcelona:<br />
• €2.50 per person per night for 5 star hotels<br />
• €1.25 for 4 star hotels<br />
• €0.75 for all other hotels<br />
• Applicable for a maximum stay of 7 consecutive nights<br />
• Applicable to anyone aged 17 years and upwards<br />
The tourist tax will be payable by the guest on arrival at the hotel.<br />
Arrival Date (dd/mm/yy): / / 2013<br />
Departure Date (dd/mm/yy): / / 2013<br />
Name:<br />
V.A.T Number:<br />
Address:<br />
STEP 4: TOTAL PAYMENT DUE<br />
Nº Rooms ......... x Nº Nights ......... x Price per night....... =<br />
TOTAL DUE €<br />
LOCAL SECRETARIAT<br />
GRUPO GEYSECO <br />
C/ Marina, 27<br />
<br />
08005<br />
Barcelona<br />
(SPAIN) <br />
T<br />
+34 93 221 2242<br />
F<br />
+34<br />
93 221 7005 <br />
www.geyseco.es/esgar2013<br />
esgar2013@geyseco.es
JUNE 4-7<br />
ESGAR 2013 European<br />
BARCELONA<br />
SPAIN<br />
Society<br />
of Gastrointestinal<br />
and Abdominal<br />
Radiology<br />
STEP 5: PAYMENT DETAILS<br />
q<br />
Option A: Credit Card<br />
Please charge the total amount mentioned (step 5) to my<br />
credit card<br />
m Visa m Mastercard<br />
Card Holder’s Name:<br />
Card Number:<br />
Expiry Date:<br />
Signature:<br />
q<br />
Option B: Bank Transfer<br />
Participants paying by bank transfer are requested to send a<br />
copy of the bank transfer to the organizing secretariat by fax<br />
or by e-mail. Bank charges are the responsibility of the payee.<br />
Name of the bank: LA CAIXA<br />
Bank Address: C/ Aragón 174-176 08011 BARCELONA/ SPAIN<br />
Bank account: 2100 3461 44 2200029790<br />
Iban: ES82 2100 3461 4422 0002 9790<br />
Bank swift code: CAIXESBBXXX<br />
STEP 6: Forward this Registration form with<br />
payment to:<br />
Conference Secretariat<br />
Grupo <strong>Geyseco</strong> S.L.<br />
Marina 27 bajos 08005 Barcelona (Spain)<br />
Fax. +34 93 221 70 05<br />
BOOKINGS WILL NOT BE ACCEPTED WITHOUT CORRESPONDING PAYMENT.<br />
LOCAL SECRETARIAT<br />
GRUPO GEYSECO <br />
C/ Marina, 27<br />
<br />
08005<br />
Barcelona<br />
(SPAIN) <br />
T<br />
+34 93 221 2242<br />
F<br />
+34<br />
93 221 7005 <br />
www.geyseco.es/esgar2013<br />
esgar2013@geyseco.es
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