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 (+ 8 € per lunch):  
Mon
18.07
Tue
19.07
Wed
20.07
Thu
21.07
Dietary preferences:  
I would like to take part in the excursion:  * YES NO
I would like to attend the Conference Dinner at 21.07:  * YES NO
Accommodation - I choose: * University residence - High Standard
Single room (price 28 € / day)
Double room (price 23 € / day)
day Sun
17.07
Mon
18.07
Tue
19.07
Wed
20.07
Thu
21.07
Fri
22.07
 accommodation 
breakfast - 4€ 
University residence - Medium Standard
Single room (price 23 € / day)
Double room (price 18 € / day)
day Sun
17.07
Mon
18.07
Tue
19.07
Wed
20.07
Thu
21.07
Fri
22.07
 accommodation 
breakfast - 4€ 
University residence - Student's Standard
Single room (price 18 € / day)
Double room (price 10 € / day)
day Sun
17.07
Mon
18.07
Tue
19.07
Wed
20.07
Thu
21.07
Fri
22.07
 accommodation 
breakfast - 4€ 
Own reservation
Accompanying person:  
Name & surname:
 
Lunch (+ 8 € per lunch):
 
Mon
18.07
Tue
19.07
Wed
20.07
Thu
21.07
Excursion for accompanying person:
 *
YES NO
Conference dinner for accompanying person:
 *
YES NO
Accommodation for accompanying person:
 *
University residence - High Standard
Single room (price 28 € / day)
Double room (price 23 € / day)
day Sun
17.07
Mon
18.07
Tue
19.07
Wed
20.07
Thu
21.07
Fri
22.07
 accommodation 
breakfast - 4€ 
University residence - Medium Standard
Single room (price 23 € / day)
Double room (price 18 € / day)
day Sun
17.07
Mon
18.07
Tue
19.07
Wed
20.07
Thu
21.07
Fri
22.07
 accommodation 
breakfast - 4€ 
University residence - Student's Standard
Single room (price 18 € / day)
Double room (price 10 € / day)
day Sun
17.07
Mon
18.07
Tue
19.07
Wed
20.07
Thu
21.07
Fri
22.07
 accommodation 
breakfast - 4€ 
Own reservation
Notes for the organizers:  

Registration fee:
Accompanying person fee:
Lunch cost:
Lunch for accompanying person:
Accommodation, Breakfast, Supper:
Accommodation, Breakfast, Supper for accompanying person:
Donation:
Total payment:

  
Enter the result of the following operation:
Kkaptia
 


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