Application Form

APPLICATION FORM
XIV ENCUENTRO INTERNACIONAL DE INVESTIGACION EN ENFERMERIA
14TH NURSING RESEARCH CONFERENCE
BURGOS, from the 9 to the 12 of NOVEMBRE OF 2010
Surname ................................................................................. ................................First name......................................................
Address................................................................................... City ................................................................................................
................................................................ Post Code............................................... Country..........................................................
Telephone ……………………………………………Fax ........................................... E-mail ............................................................
ACCOMMODATION (Price per bedroom and night // TAX AND BREAKFAST INCLUDED as today 01/07/2010, 8% VAT)
SINGLE ROOM
DOUBLE ROOM
HOTEL NH PALACIO DE LA MERCED 4*
103,00 €
118,00 €
HOTEL AC 4*
110,00€
123,00 €
HOTEL SILKEN GRAN TEATRO 4*
88,00 €
96,00 €
HOTEL ABBA 4*
81,00 €
91,00 €
HOTEL VELADA 4*
75,50 €
105,00 €
HOTEL MESON DEL CID 3*
74,00 €
84,00 €
HOTEL RICE 4*
69,00 €
80,50 €
HOTEL MARIA LUISA 3*
63,50 €
74,50 €
HOTEL CORONA DE CASTILLA 4*
63,50 €
73,50 €
HOTEL HUSA ARLANZON 4*
61,00 €
74,50 €
HOTEL PUERTA DE BURGOS 4*
66,00 €
71,00 €
HOTEL
CHOOSEN HOTEL.............................................................................................................................
TIPE OF ROOM
[_] DOUBLE
[_] SINGLE
CHECK IN ..................................................... CHECK OUT ......................................
TOTAL AMOUNT
NIGHTS.............. ............
=
PAYMENT
o Credit card: [_] VISA [_] AMEX [_] DINERS [_] MASTER CARD [_] CORTE INGLES CARD
Card number (16 dígits) ...................................................... Holder............................................................................................
Exp. date .............................. I authorise the total amount to be charged to my credit card. Signature ......................................
o Bank transfer:
Account Number from out of Spain: BBVA 0182 3999 37 0200664662
ES97
It is Indispensible to send a copy of the transfer by fax: 947 27 76 64
Important: Every extra charge due to the bank transfer will be paid by the sender.
BBVAESMMXXXX
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------REMARKS:
Application received without payment will not be accepted.
Date limit: 10 / 10 / 2010.
The personal details included in this document, are of a confidential nature. In accordance with the Constitutional Law 15/1999, of 13
December, the holder of this data will be able to exercise his or her right of access, rectification and cancellation on written application to:
Viajes El Corte Inglés, S. A; Servicios Centrales - Dpto. de Organización y Métodos. Avda. de Cantabria, 51; 28042 – Madrid.
To be send fully completed by post or by fax to:
Viajes El Corte Inglés - C/ Vitoria, 48 - 09004 - Burgos
Tfno: 947 27 20 02 // 947 27 23 92 Fax: 947 27 76 64
e-mail: [email protected] Contacto: Antonio Rodríguez // Sandra Yagúez