Project TE01020028 / Center for Development of Original Drugs is realized with financial support from the Technology Agency of the Czech Republic (TA ČR).
Download in PDF
Congress Business Travel spol. s r.o.
Lidická 43/66, 150 00 Praha 5 - Anděl
Please check the contents of this form carefully as you will not be
able to make modifications after submission. If it is necessary to
change any information after submission, please e-mail or a fax the
changes to the Organizing Office: firstname.lastname@example.org;
fax: +420-224 942 550.
For your convenience the system will remember your personal data. The system will forget your personal data if you close this window or stay on this page for more than 30 minutes without submitting.
= required field(s)
Title, First name
Family name, Title
Registration fee includes:
I would like to present a poster
If you enter an incorrect credit card number, or if your credit card is not authorised for another reason, the registration process will be cancelled automatically.
I authorize Congress Business Travel Ltd. (Lidicka 43/66, 150 00 Prague 5, Czech Republic, VAT number: CZ26424053) to charge my credit card for the payment of EUR: + % administration fees =
Card typeSelectAmerican ExpressVISAMasterCard/EuroCardDiners
Card holder's name*
Expiry date (mm/yy)
CVV/CVC code (last 3 digits)**
Billing address (AMEX)
*) In case the name of cardholder and name of registered delegate is different, Conference Secretariat has the right to ask cardholder for approval. Please fill in here all requested details.
**) CVC2 (MasterCard/EuroCard) or CVV2 (American Express, Visa, Diners) code is printed on the reverse side of your credit card on the signature panel, (last three digits).
In case you need to issue an invoice or if someone else is paying your registration fee, please, tick the following box.
If you require pro-forma invoice, please state it in the VI. Notes section.
Different payer or invoice
CountrySelect countryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua-BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia-HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurma (Myanmar)BurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChechnyaChileChinaColombiaComorosCongo, RepublicCongo, Democratic Rep.Costa RicaCote d IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent-GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamPalestineWestern SamoaWestern SaharaYemenYugoslaviaZambiaZimbabwe
Phone+ (+420 123456789)
Please add any information you regard as important
I agree with the use of my personal data by the company Congress Business Travel spol., s r.o., in accordance with the Czech Personal Information Protection Act 101/2000 Sb. The data will be used solely for the purposes of this conference; giving consent is a necessary condition of your registration.
4th year of the Prague Summer School Advances in Drug Discovery | Contact us