REGISTRATION FORM

Name (as it will appear on the badge):

Credentials: MSc / PhD / Prof (underline)

Affiliation:

Street:

City / ZIP Code / Country:

E-mail:

Title of Presentation:

Dietary or Other Special Requirements:

I need a proforma invoice for the conference fee: YES / NO (underline)

If YES:

VAT / Tax ID: (if applicable)

Please, indicate if the address on the invoice is different than Affiliation:

I need an official invitation for visa: YES / NO

If YES:

Date of birth:

Passport number:

Please, send this form to the Organizing Committee by June 14, 2019:

igrulkowski@fizyka.umk.pl

Please, make sure that the conference fee is paid before the conference.