Personal data:

1. First name:
2. Last name:
3. e-mail address:
4. sex:
   • male
   • female
5. Position:
   • undergraduate student
   • graduate student (PhD student)
   • postdoctoral fellow
   • professor
6. Institution:
7. Address:
   • street:
   • postal code: , city:
   • country:
8. Phone: , Fax:

Scientific part:

1. Do you plan to present a poster?
   • yes
   • no
2. If so, what is the title and the abstract of your poster?
   • the poster title:
   • the poster abstract:
     

Accommodation / finance / misc:

1. What kind of accommodation do you prefer?
   • single room
   • double room shared with another participant (suggest your roommate: )
   • double room with accompanied guest
   • no accomodation
2. Are you planning to take part in the celebration of Prof.Rzazewski's birthday?
   (cost of the banquet 200 zl)
   • yes
   • no