Surname:

Name:

Address:

City:      Country:

Post Code:      Telephone:        Fax:

E-mail:     Sex:

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ACCOMMODATION

	Double:	Single:
Residencia "El Burgo"		27 €
Residencia "Monte da Condesa"	44 €

Nº of persons:    

Nº of rooms:   

Check-in date:   

Check-out date: 

Total nights:   

Total cost of accommodation:   

Prices per room and night including VAT.

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Methods of payment:

Bank transfer to account number 2080-0156-49-0040005041 at CAIXANOVA (Santiago de Compostela, Rosalía de Castro nº 83) Transfer code for the Euro area: IBAN:  ES51 2080 0156 4900 4000 5041 SWIFT:  CAVIES2V Credit card payment:                         VisaMastercard                           Nº Expiry Date:                           Postal Order

Notice:

PLEASE COMPLETE AND MAIL THIS BULLETIN ENCLOSING A COPY OF PROOF OF PAYMENT PRIOR TO JUNE 1ST 2004 TO:

III Congreso Internacional Historia a Debate
Apartado de Correos 427
15780 Santiago de Compostela (España)
Tel.: 981 52 80 58 Fax: 981 81 48 97
h-debate@cesga.es
www.h-debate.com

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