A Truly International Gathering

RSCDS INTERNATIONAL BRANCH SCD WEEKEND IN PRAGUE 10-13 JUNE 2011

APPLICATION FORM (one per person) PLEASE PRINT

Address: Town: Country: Postcode: Telephone: E-mail: IB-membership number: Contact in case of emergency: To help us organise the classes, please supply the following information: Age:  under 20  20-40  40-60  over 60 I have been dancing since: I am interested in:  technique  social dancing

Due to the current currency fluctuations, the sterling price will be monitored and changed if necessary - if you are paying in pound sterling, please e-mail us at [email protected] before you pay.

Please tick as applicable Price Basic workshop package  €110/£92 (classes, three evening dances, tour of Prague)  IB member: €100/£84 Non-dancer package (tour of Prague, admission to the evenings)  €20/£17  sharing a double/twin: €170/£143 Accommodation at Hotel Beranek (includes all meals)  single room: €240/£201 TOTAL WORKSHOP TO PAY

1 I would like to share a room with ...... and would prefer a  quiet room  party room  no preference

My dietary requirements are: …………………………………….

I will be travelling by air/rail/sea/road, arriving in Prague on (date) …………………at (time) ………………..…

2 Please also let us know if you require information about:

 Non-dancing package during the workshop  Accommodation before the workshop  The sightseeing/dancing holiday organised by Dvorana from 13-18 June 2011  Anything else we can help you with

How to pay

Important! Please note that all transfer charges must be paid by the applicant. Don’t forget to mention “Prague 2011”, your name, and the names of anyone else included in the payment.

By bank transfer to our Euro account: The International Branch of the RSCDS Banque et Caisse d’Epargne de l’État, Luxembourg IBAN account number: LU05 0019 1955 4239 6000 BIC code: BCEELULL

By bank transfer to our sterling account: The International Branch of the RSCDS Royal Bank of Scotland Account number: 00621190 Sort code: 83-17-23

By sterling cheque drawn on a UK bank: Please make the cheque payable to the International Branch of the RSCDS and post it together with this application form to: Susi Mayr, Bergsteiggasse 7/3/17, A-1170 Vienna, Austria

By PayPal: Please send you payment to the following email address: [email protected]

Please note that a non-refundable deposit of €50/£42 is due together with the application form by 31 January 2011. Places will not be confirmed until the non-refundable deposit has been received. Balance of fees is due by 30 April 2011. 50% of the fee paid (minus the deposit) will be refunded for cancellations made by 31 May 2011. No refunds will be made for cancellations after 31 May 2011.

Grand total due  bank transfer  cheque Total remitted with this application  PayPal (please tick all that apply)  deposit only  full fee Total due by 30 April 2011

I understand that the International Branch of the RSCDS is under no liability whatsoever in respect of any personal injury or loss which I may sustain and I agree to conform to any rules or regulations which may be made from time to time and which govern my visit to the Prague IB workshop and sightseeing programme.

Signed: ______Date: ______