Boletín de Inscripción - International Workshop on Functional and

International Workshop on Functional and Operational Statistics
Venue : Fundación Barrié. Cantón Grande 9 15003 A Coruña
A Coruña, 15th and 17th of June 2017
To be send by fax or e-mail properly filled out
VIAJES EL CORTE INGLES,S.A. Events. Avda de Rubine 3-5 15004 A CORUÑA
Telf.: 0034 981-261020 ext. 3 – Fax.: 0034 981-272539 --- E-mail: congresoscoruna@viajeseci.es
I N S C R I P T I O N
F O R M
Surname :
First name :
ID Card/ Passport. :
Address:
Locality :
Zip Code :
Phone number:
Fax:.
Province:
E-Mail:
H O T E L S
HOTEL
1
2
3
4
5
6
7
8
Double Room
Double Room for
Single Use
132,00 €
112,00 €
83,97 €
82,50 €
84,00 €
80,00 €
77,00 €
60,50 €
121,00 €
101,50 €
74,97 €
71,50 €
73,00 €
70,00 €
71,50 €
55,00 €
Htl. NH Atlántico 4***
Htl. Zenit 4****
Htl. Riazor 3***
Htl. Hesperia Coruña 4****
Htl. Plaza Coruña 4****
Htl. Blue Coruña 4****
Htl. María Pita 4****
Htl. Tryp Coruña 4****
Prices are per room and night. Breakfast and VAT (on 2016) included. In case that the VAT changes we will
be obligated to modify the rates.
HOTEL 1): ……………………………………………..…….……..
2) …………………………….……….………… ….
DOUBLE ROOM : …………..…………..
DOUBLE ROOM FOR SINGLE USE : …….………..…….…….
ARRIVAL : ............./ ............./ ..............
DEPARTURE : ............./ ............./ ...........
NIGHTS: ..................

T O T A L : … … … EUR
P A Y M E N T
PER BANK TRANSFER (free of bank service charge) * indispensable sending copy of payment
Banco Santander Central Hispano . Pza de Canalejas 1 – 28014 Madrid
Cta.: 0049 1500 03 2810355229
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MASTER CARD:
AMEX:
El Corte Ingles:
Credit Card Holder : ……………………………………………………………………………………………..
Credit Card Number : ……………………………………………………………………………………
Expiration Date : ………………………………………
I authorize Viajes El Corte Inglés to charge the indicated amount to my credit card
Date :
Holder’s Signature :
Notes :
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The inscription form has to be signed and afterwards send by per fax or e-mail.
Insc
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