Tytul

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Organized by Institute of Experimental Physics,
University of Bialystok

under auspices
of the Committee of Crystallography, Polish Academy of Sciences

Registration Form

You can fill in the form below to pre-register for the school. Fields labelled blue are mandatory and you cannot leave them blank. Other fields are optional.
If you have any questions, please e-mail us at school@alpha.uwb.edu.pl

Personal information

Mr Ms

First name:

Family name:

Title: Prof. Dr. PhD student Undergraduate

Institution:

Address:

City/code:

Country:
(Choose your country from list or type its name in the textfield)

E-mail address:

Telephone:

Fax:

I will be accompanied by...

First name:

Family name:

Preferences about room sharing

Single rooms will be available at the additional cost of 100 EUR (limited number available, booking and payment should be made before May 15th, 2004).

I wish a single room

Contributed talk and Poster session

I wish to present a poster
Tentative title:

I wish to present a talk
Tentative title:

Arrival and departure

Arrival date: Approx. time: Place:

Departure date: