from ROOTS to FRUITS Jewish Women of Today

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1 page 1 of 5 pages 22nd ICJW QUADRENNIAL CONVENTION May 2-8, 2014 Hotel Intercontinental, Prague, Czech Republic from ROOTS to FRUITS Jewish Women of Today Please complete and return this form, along with payment, to: CCJW Prague, Maiselova 18, CZ Prague 1, Czech Republic Phone icjw.prague@yahoo.com Web: PLEASE NOTE: COMPLETED FORM AND PAYMENT MUST BE RETURNED TO CONVENTION OFFICE. I. Identification Delegate Please complete this section carefully. The information you provide will allow us to correspond with you efficiently and ensure that your name and coordinates will appear correctly on your conference material. Title (Dr/Prof/Mr/Mrs/Miss/Other): Position: Organisation: Postal address: Postcode: Phone : Country: II. Identification Registered Accompanying Person Accompanying persons are not entitled to attend ICJW business sessions. III. Registration Fees Category: Registration Fee: Delegate Fee Early Bird International Registration Fees (Early Bird Fee if paid before 31 December 2013) USD $385 Delegate Fee Standard International Registration Fees USD $395 Accompanying Person Registration Fee USD $375 Subtotal Registration Fee USD $

2 page 2 of 5 pages IV. Pre- and Post-Convention Executive Meeting Attendance Will you be attending the Pre Convention Meeting Will you be attending the Post Convention Meeting Executive Meeting Registration Fee $35.00 USD Friday 2 May 2014 Sunday 4 May 2014 Thursday 8 May 2014 Include this fee in your grand total V. Social Events - Optional (Delegate & Accompanying Person) Kindly note that events marked with * are covered by the registration fee and the price for those events is applicable only for unregistered accompanying persons. Shabbat Dinner at the Jewish Community Prague Opening Gala Dinner * 1 day tour No. 1: Trip to Melnik Castle with wine tasting Friday, 2 May 2014 USD $35 pp No. of persons: Total $: Sunday, 4 May 2014 USD $100 pp No. of persons: Total $: Sunday, 4 May 2014 USD $65 pp No. of persons: Total $: Thematic Dinner * Monday, 5 May 2014 USD $70 pp No. of persons: ½ day tour No. 1: Architecture of Prague & Mozart Total $: Monday, 5 May 2014 USD $30pp No. of persons: Total $: Thematic Dinner * Tuesday, 6 May 2014 USD $70 pp No. of persons: Total $: ½ day trip to Terezin Stadt Holocaust Memorial * ½ day trip tour No. 2: Prague Castle & Franz Kafka's Prague Tuesday, 6 May 2014 USD $35 pp No. of persons: Total $: Wednesday, 7 May 2014 USD $30 pp No. of persons: Total $: Closing Gala Dinner * Wednesday, 7 May 2014 USD $100 pp No. of persons: Total $: Subtotal For Events: $ VI. Accommodation / Housing Information Please select and indicate the type of room(s) you would like to reserve. All rates are per person per night. Hotel rates include breakfast and 15% VAT. Payment for Accommodation must be paid upon arrival when registering at the hotel. Hotel Intercontinental Single Room Double Room Per Person Per Night Check in Date Check out Date No. of Nights Classic Room USD $222 USD $116 Junior Suite USD $358 USD $184 One Bedroom Full Suite USD $560 USD $285 Club Lounge Access Supplement USD $40 USD $35 Subtotal: $

3 page 3 of 5 pages ** NO DEPOSIT REQUIRED** Please DO NOT SEND a separate request for accommodations. The information on this registration form is sufficient. VII. Airport Transfer and Flight Details Kindly use Prague airport taxi services AAA Taxi by the airport exit or order the hotel taxi from Intercontinental Hotel ( concierge@icprague.com) Date Flight No. & Details Time Arrival Date: Departure Date: VIII. Summary of Payments Description Total USD III. Registration Fees (Participant& Accompanying Persons) IV. Pre- and Post-Convention Meeting VII. Social Events GRAND total Paid IX. Dietary Requirements /Special Requests All convention meals will be kosher, including field trips. Disability access my requirements are: Special diet requests (food allergy, no meat, etc): X. Language preferences What is your PRIMARY language: List any other languages you speak: XI. Room Sharing If sharing a room, name of person

4 page 4 of 5 pages XII. Payment Options Payment of all fees noted on this Registration Form must accompany this form. Payment may be made either by Credit Card or by Bank Transfer. Please indicate below the type of payment you select. It is important to indicate the delegate s name on bank transfers and draft to facilitate correct processing of your registration. Bank charges are for delegate s own account so it is important to ensure you transfer sufficient funds. Bank Transfer: I have requested my bank to make an electronic transfer and will send you a copy of documents. Bank Draft: I have requested a bank draft and will send it to you via post. Credit Card: I authorize you to debit my credit card with the amount below. Prague Bank Transfer details: Name of bank: Fio banka as Addess: V Celnici 10, CZ Prague 1, Czech Republic Name of the account holder: CCJW IBAN: CZ SWIFT/BIC: FIOBCZPPXXX Currency: USD Your Bank Account Details: If wiring funds, please use ONLY THE EXACT information provided here. Please note: you are responsible for any bank wiring charges which may apply. NB. It is important to or mail a copy of the funds transfer document to the Convention Office: CCJW Prague Maiselova 18, CA Prague 1 Czech Republic icjw.prague@yahoo.com Credit Card Details: Cardholder s name: Card number: Visa Mastercard AmEx Diners Amount: $ Expiry Date: CCV No.: (last three digits on back of card if available) Passport Number: Issuing Country: SIGNATURE: DATE:

5 page 5 of 5 pages XIII. Conditions The following deadlines and conditions apply to all registrations for the 22 nd ICJW Convention in Prague, Czech Republic. Please read them carefully. If you have any questions about these conditions, please contact the Convention office at icjw.prague@yahoo.com. - Full payment of all fees must accompany Registration Form. - All cancellations must be received in writing. - If a cancellation is received prior to March 1, 2014 a full refund will be made less 15% Administrative fee. - For all cancellations received in writing between March 1, 2014 and April 15, 2014, 50% will be refunded less the 15% administrative fee. - Delegates with outstanding fees will be liable for a 50% penalty for unpaid fees. - Cancellations made after April 15, 2014 will be ineligible for refund. However fully paid registration fee may be transferred to other delegates who may not have already registered. - No Shows will be liable for the full registration fee and an accommodation fee equal to one night s cost for the hotel of delegate s reservation. We regret that we cannot offer refunds for No Shows. However, delegates who are unable to attend may send a substitute to participate without incurring any penalty. I have read and agree to all conditions specified above. Signature Date