Registration form for the 2024 International Convention

First name (as on passport - e.g. Robert)*

Nickname (if applicable - e.g. Bob)

Surname (as on passport - e.g. Wilson)*

Address (street)*

Postcode/Zip code*

Town*

Province/State

Country*

—Seleziona un'opzione—ArgentinaAustraliaBelgiqueBotswanaČeská republikaDanmarkDeutschlandEspañaFranceGreat BritainIndiaIrelandIsraelItaliaLuxembourgMagyarországMauritiusMéxicoN. IrelandPolskaSlovenskoSouth AfricaSuisseSverigeUSAZimbabwe

Telephone/Mobile*

E-mail*

Re-enter e-mail*

Date of birth*

Place of birth*

Oasis/Reality to which you belong*

—Seleziona un'opzione—Alto AdigeArgentinaAustraliaBelgiqueBiellaBlotnicaBridgeportCamparmòČeská republikaChemnitzCogolloEspañaFranceFuldaGesiaGreat BritainHamburgIndia NorthIndia SouthIrelandIsraelItalia Nord OvestKölnKrakówLos AngelesLuxembourgMagyarországMauritiusMéxicoMinnesotaMünchenNew YorkNowy RadzicPittsburghPrešovPuglia SudRecanatiRegion CentralnyRomaSardegnaSiciliaSklenéSouth AfricaSuisseSverigeVyšný KlátovWrocławZimbabwe

Gender*

FM

Citizenship*

Passport/National identity card no.*

I require translation in*

Nessuna traduzione - parlo italianoČeskyDeutschEnglishEspañolFrançaisPolskiSlovensky

Choose the option you are interested in*

Convention with double/triple bedroom accommodation: €250Convention with single bedroom accommodation: €315**

If possible I would like to share a room with:

Person 1

Person 2 (if you prefer a triple bedroom)

Food allergies or other needs:

I have read and accept the conditions and privacy policy.***

*This symbol indicates a mandatory field.

**Single bedrooms are subject to availability.

***Personal data will be recorded in the electronic archives of Koinonia Giovanni Battista, in conformity with Czech law 101/2000 concerning privacy.