Registration

Application Form

Data marked in red are essential

Type of registration

I apply for participation:	preliminary	Update of record:
	final	Update of record:

Personal data

Name:
Surname:	UPPER CASE
Academic Degree:
Password:
Confirm Password:

Address

Office:
Street:
City:
City code:
Country:

Contact

e-mail address:
Phone, resp. Fax:

Presentation I apply:

entitled:

Special software and hardware requests:

I book the following meals and accommodation during the symposium

Date	Breakfast	Lunch	Dinner	Bed
Wednesday 17.10.2012	not served
Thursday 18.10.2012
Friday 19.10.2012			not served

Note:	Mark the chosen meals in the table.
	Vegetarian diet can be indicated below, in the Notes and comments.

Notes and comments:

If the submission of the application form failes,
and you insist on electronic registration, you can use
the Word file: application.doc as attachement in an e-mail
message sent to the address of the symposium.

Please, fill in and forward also the form Conference Fee after the payment.