Registration on-line

Artbreak date
27.5.-2.6. 2012 17.6.-23.6. 2012 30.9.-6.10. 2012

Contact information

Title Mr. Ms. Mrs. Dr. Prof.	Street Address	Country*
First Name*	City*	Citizenship*
Family Name*	Occupation	Your email address*

* Required Information

Registration

	I will be attending artbreak™ alone.	49,000 CZK (currency converter)
	I will be attending artbreak™ with someone else (registered below), and we will be sharing a hotel room. I understand that we are eligible for an artbreak™ fee reduction based on double occupancy.	80,000 CZK (currency converter)
	I will be bringing a non-participating guest (registered below), who will be sharing my hotel room. I understand that my guest is eligible to attend the afternoon sherry hours but cannot take part in the morning arts classes or attend the evening performances.	52,000 CZK (currency converter)

Guest with you at the hotel, (either as an artbreak™ attendee or non-participating guest).

First & Family Name*

Citizenship*

Payment method

Credit Card (Visa or MasterCard)

Wire transfer We will e-mail you payment instruction.

Comments

You can write additional information here to assist us with your application.