Kindly fill in this form with capital letters and send it to the following address:
Secretaría Técnica. C/ Princesa, 47 – 6º ,  28008 Madrid. Tel: +34 91 454 6014; Fax: + 34 91 559 44 43
E-mail: oscetravelagency2007@viajeseci.es .   Contacts: María Pérez/ Lorena Zabaleta

Delegate information:
 
Delegation _______________________________________ 
Name _____________________________  Family Name _________________________________________
Title    ________________________________ Position _______________________________
Mailing Address__________________________________________________________________________
Postal Code______________  City  ______________________  Country ____________________________
E-mail ______________________________ Telephone ____________________  Fax _________________

	 A. ACCOMMODATION	

Hotel ____________________________________________________________				
Check-in date _________________  Check-out date ____________  Nº of nights: ________
Nº persons ____________________    Nº rooms ___________
S Subtotal A___________€	

	 B. TRANSFERS	

Note: A shuttle service is provided from and to airport and hotel. If you wish to use this service please fill in below.

Day of arrival to Madrid _______at ________ hours   Flight nº _____ of the airline company __________origin _________
Day of departure to Madrid  ______ at ________ hours   Flight nº _____ of the airline company _______
            
	D. AMOUNT TO PAY	
STOTAL AMOUNT TO PAY................................................ €	

Method of Payment:

•	Credit Card: 

VISA  						MASTERCARD 	
		
AMERICAN EXPRESS 				DINERS CLUB  				

-	First name / Last name.............................................................................................................

-	Credit card number..................................................................................................................							
-	Expiry date.............................................................................................................................

-	CVC Number* …………………………………………………………………………………………………………………….
* ( On the back of your credit card, in the signature strip, you will find the last 4 digits of your card number and the digit CVC number, important for the security of the payment)

-	Amount to pay........................................................................................................................

* I hereby authorise to charge in my credit card the amount of _________________ Euros.

Credit Card Holder Signature

•	Bank Transfer:

 Bank transfer from Spain
BANCO SANTANDER CENTRAL HISPANO.
Nº CUENTA : 0049 1500 03 2810355229

 Bank transfer outside Spain
BBVA .- C/ALCALÁ, 16  28014 MADRID (SPAIN)
Nº CUENTA: ES9701823999370200664662
CODIGO: BBVAESMMXXX

IMPORTANT NOTE: 
Registration will be not processed if the Form is not fully filled out and the payment is not made.
Please send the accommodation form and a copy of the bank transfer either by post, email or fax (+ 34 91 559 44 43).

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