Main Page -> Registration on-line form




Surname:  *
First name:  *
Title:  
Gender:   Male Female
E-mail:  *
Country:  *
University/Institution address
to be printed on official documents:
 *
Tax Identification Number (NIP):  
Address of correspondence:  *
I wish to present a paper:  * YES NO
Paper title:
 *
Special requirements for technical support of my presentation:
 
I wish to present a poster:  * YES NO
Poster title:
 *
I wish to conduct Workshop:  * YES NO
Workshop title:
 *
Special requirements for technical support of my workshop:
 
I will take part in the
Working Seminar for level:
 *
Lunch (+ 10 € per lunch):  
Mon
11.07
Tue
12.07
Wed
13.07
Thu
14.07
Dietary preferences:  
I would like to take part in the excursion at 12.07:  * YES NO
I would like to attend the Conference Dinner at 13.07:  * YES NO
Accompanying person:  
Name & surname:
 
Lunch (+ 10 € per lunch):
 
Mon
11.07
Tue
12.07
Wed
13.07
Thu
14.07
Excursion for accompanying person:
 *
YES NO
Conference dinner for accompanying person:
 *
YES NO
Notes for the organizers:  

Registration fee:
Accompanying person fee:
Lunch cost:
Lunch for accompanying person:
Donation:
Total payment:

  
Enter the result of the following operation:
Kkaptia
 
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