The Organizing Committee of the Third International Conference ...

fax number: +48 (61) 662 16 65
e-mail biuro@bokiz.pl
Company Name:……………………………………………………………………………………………………………………………………………………………………………………………………
Company Address: …………………………………………………………………………………………………………………………………………………………………………………………………
E-mail address: …………………………………………………………………
Telephone number: ……………………………………………
Tax number:………………………………………………………………………
Name and surname of the company’s conference representative:……………………………………………………………………………………………………………………
Telephone number (mobile):………………………………………………………………
E-mail address:……………………………………………………
Correspondence address (if other than the company address):…………………………………………………………………………………………………………………………
We are applying for:
Title: Strategic partner
Satellite session (90 min., during the first day)
10 sq meters of preferential exhibition area including the following equipment:
1 table, 2 chairs, switch board - 3 x one-phase circuit
This fee will also cover: 3 Id badges, lunch during the Conference, 3 invitations for the
Social event and one conference material’s pack
Advertisments printed within the program (and other conference materials)
Company logo on the website, on the official programme, etc (better exposed, at least
200% of the other’s Partners logo surface)
Inserting advertising materials inside the conference packs.
Placing a free standing advertisment – roll-up
within the conference premises (outside of the exhibition area).
Title: Main Partner
Satellite session (60 min.)
5 sq meters exhibition area including the following equipment:
1 table, 2 chairs, switch board - 3 x one-phase circuit
This fee will also cover: 2 Id badges, lunch during the Conference, two invitations for the
social event and one conference material’s pack.
(Representatives are not permitted into the lecture room)
Company logo on the website, on the official programme
Placing advertising materials inside the conference packs.
Placing a free standing advertisment – roll-up
within the conference premises (outside of the exhibition area).
Title: Partner
5 sq meters exhibition area including the following equipment:
1 table, 2 chairs, switch board - 3 x one-phase circuit
This fee will also cover: 2 Id badges, lunch during the Conference, two invitation for the
social event and one conference material’s pack.
Company logo on the web site, on the official programme
Miscellaneous Options (please check the availability first)
Additional exhibition area
An additional Id badge for the company representative, including lunch during the
Conference and an invitation for the Gala dinner.
(Representatives are not permitted into the lecture room)
Other (consulted with the Organising Committee)
yes/no
yes/no
yes/no
No. of m 2 200
Quantity
20000 €*
15000 €*
10000 €*
€* per 1m²
200 €* per 1
total net price
…………………………€
* - net prices (22% VAT)
The TOTAL fee of ………………………€ net (+23% VAT) will be transferred to:
Nordea Bank Polska S.A., (PL) 56 1440 1286 0000 0000 0214 2988 (swift: NDEAPLP 2)
Adding a note: „ACN2012”
Applications can be cancelled through fax until 31.01.2012. After this deadline all cancellations will obligate for a payment.
We confirm that we have read all of the conference participation terms and conditions and that we will issue an according payment.
We confirm that we will deliver the full and final list of the company representatives before 31.05.2012.
Any arguments which may result from this application will be resolved according to the Polish law by the court appropriate for the mandatory party.
Any personal information may be used for statistical purposes only, by the Fundacja Uniwersytetu Medycznego im. Karola Marcinkowskiego Poznan
(according to the Personal Data Protection Act from the 29th Aug 1997; Dz. U Nr 133 poz. 883), which we (the applying company) do accept.
Main Accountant Stamp Company Director/Chairman