<p> REGISTRATION FORM Workshop on “Contaminated Lands in Accession Countries: Benchmarking Historical Heritage and National Actions” REC Conference Center November 17-18 , 2003</p><p>Please fill out this form and return to Ms. Eva Peto by October 31, 2003 Regional Environmental Center for Central and Eastern Europe (REC), 2000 Szentendre, Ady Endre út. 9-11. Hungary Tel: (36 26) 504 000 Fax: (36 - 26) 301 191, E-mail: [email protected]</p><p> with a copy to Madeleine Rizzi, fax: +39-0332-786272, E-mail:[email protected]</p><p>PLEASE PRINT:</p><p>Name:Surname:</p><p>Title in the Department:______</p><p>Department:______</p><p>Organization:_</p><p>Address: ______</p><p>City: Zip code: </p><p>Country: ______</p><p>Telephone:______Fax:______</p><p>E-mail:______Please print in capital block letters!</p><p>TRAVEL INFORMATION</p><p>If you plan to attend, please fill out the information below. If you do not have your travel information by the submission date of the registration form, please send to us separately as soon as possible.</p><p>ARRIVAL DATE AND TIME:</p><p>Day/month:   I am arriving by Airline/Flight No. at A.M.  P.M.  I am arriving by rail at   A.M.  P.M. to  Keleti ,  Deli,  Nyugati Rail Station</p><p>Name / number of the train:______ I am driving to the meeting. </p><p>DEPARTURE DATE AND TIME: Day/month:  I am scheduled to depart by Airline/Flight No. at  A.M.  P.M.  I am leaving by rail at______ A.M. P.M. from  Keleti ,  Deli,  Nyugati Rail Station</p><p>Please turn to next page!</p><p>1 TRANSFER ARRANGEMENTS  Please arrange transfers Airport / Rail station-Szentendre-Airport / Rail station  I will make my own transfer arrangements</p><p>HOTEL RESERVATION  Please make a reservation in Szentendre for November _____/______for ______number of nights  I do not need hotel reservation Your room will be guaranteed for late arrival. If for any reason you need to cancel or change your day of arrival, please notify us immediately so that we can make the necessary arrangements! You will be notified of the hotel and address at a later date.</p><p>VISA If assistance with Visa is requested, please return this form by October 24 at the latest! </p><p>Passport no:______Passport type:______</p><p>Passport valid from / to: ______</p><p>Date & place of birth: ______</p><p>Permanent address:______</p><p>Nationality:______</p><p>Mother’s maiden name:______</p><p>DIETARY PREFERENCE</p><p> I prefer vegetarian food  Other preference:</p><p>2</p>