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Contact us: Tel: +7-495-988-7175 129090, Russia, Moscow, “B. Suharevskaya” Square, house 9 [email protected] World Communication Forum Davos, Moscow Regional Session Moscow, Russia 10-11 April, 2014 Please, complete the form by typing in all due information, print it, and return as a scan via email. For further queries, please email us at: [email protected] Personal information – Please type in all the requested data, as advised below! Title: -Mr. -Mrs. –Ms. -Dr. -other: (please, specify) Type “x” in the middle of the appropriate box ; Sex: -Male; -Female; Type “x” in the middle of the appropriate box First Name (Given) Middle Name Last (Family) Name ; ; ; Organization: Position held: ; ; Postal address: ; ; City: ; Postal code: ; Country: Tel: (international code - city area - number) Mobile: (international code - city area - number) Fax: (international code - city area - number) Email: Do you need a formal invitation for obtaining a visa: Type “x” in the middle of the appropriate box ; ; ; -yes; ; ; -no Contact person (if different than the participant): ; Company position: Company name and address: ; ; Phone and email: ; Contact us: Tel: +7-495-988-7175 129090, Russia, Moscow, “B. Suharevskaya” Square, house 9 [email protected] Registration Only Registration Only Gagarin’s Party* Special Fee* - for 2 events! WCFDavos’5 + WCFDavos|Moscow! (2-day Moscow) (1-day Moscow) ( 10 April, Moscow) (2-day Moscow + 2-day Davos conference) Early Bird 500 euro 300 euro Standard 650 euro 380 euro Last minute 750 euro 450 euro NB! The party is included in the amount of all types of fees! Entry Fees Type “x” in the middle of the appropriate box! 15th Dec’13 – 31st Jan’14 01st Feb – 28th Feb’14 01st Mar – 10th Apr’14 Optional* Events/Offers Type “x” in the middle of the appropriate box! Standard 1050 euro Last minute 1150 euro 15th Dec’13 – 10th Jan ’14 11th Jan – 05th Mar’14 Not available NB: No accommodation! Book online via credit card (NB: no invoice due!) (click here) Registration fees INCLUDE: The respective panels, sessions, lunches, and coffee breaks as per Final Agenda; Participant’s portfolio: prints, booklet, note-pad, pen, badge, and bag/folder. NB! Registration Only DOES NOT include any optional* events, accommodation, travel, or flight! *To make use of the Special Fee or attend any optional events, tick the appropriate box above! Claim your due 50% discount from the above-selected Early Bird, Standard or Last Minute fee if you are a member of a RPRA (RASO): 50% special discount exclusively for RPRA (RASO) members! Claim your due 20% discount from the above-selected Early Bird, Standard or Last Minute fee if you are a member of a partner association (specify which one): 20% special discount for Partner members! Partner: ; Official language of the conference is English! Would you like a translation? Type “x” in the middle of appropriate box: -yes; -no Payment as Bank Transfer in case of due invoice! (Ask for bank details at: [email protected]) (For online booking via credit card, if no invoice is necessary, please see the link in the above table!) For a Bank transfer as per Pro-Form Invoice issued upon receipt of this application (official invoice due after event - upon my request!), I’d like SE Pleon Talan, to invoice: (Company) I hereby apply for participation and registration in the above event and accept to pay the due fees’ total amount of: Euro, in words . Euro I understand the booking is subject to the below stated Terms and Conditions! Booking Terms and Conditions: 1. The contract is with Top Communication GmbH. 2. Any refund of fees will be made only for cancellations received in writing at least 30 days prior to the event. 3. A 25% cancellation charge is due to cover administration costs. No refund for books or printed/other materials/souvenirs. 4. No refunds will be made for cancellations received within 30 days before the event. 5. Top Communication GmbH reserves the right to alter or cancel the program. 6. Provisional bookings made by phone must be confirmed in writing. Participant’s signature: __________________________ Delete underlined space before inserting a digital signature, or print the form and sign before returning a scan via email!