REGISTRATION FORM

Name & Surname:

Affiliation:

Address:

Phone:

Fax:

E-mail:

Contribution:

Oral communication

Poster

Title:

Abstract:

Arrival/departure (mark from-to):
 

June 13

June 14

June 15

June 16

June 17

June 18

June 19

Hotel (approximate prices, single room per night, bills to be paid individually upon leaving):
 

University guest-room (EUR 25)

"Pod Czarna Roza" (EUR 55)

I am coming alone

with an accompanying person.

Special requests:

Conference fee:

EUR 140	Accompanying person EUR 70
I will pay later
Bank transfer to the account of   Nicholas Copernicus University   at   BIG Bank Gdanski S.A., II O/Torun Sz. Chelminska 17, 87-100 Torun, Poland Acct #: 11602068-67054001 "XXXIV SMP" (swift code: BIGBPLPW)

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