Registration Form


 

PERSONAL INFORMATION
Title:  
First name:  
Last name:  
Affiliation:  
City:  
Country:  
e-mail:  

 




 

PARTICIPATION IN THE CONFERENCE
Contribution title:  
Abstract:   The participants are requested to send an extended abstract of the talk
  electronically on the address foliations2012@math.uni.lodz.pl as an attached file(s)
  (TeX and PDF).
  The deadline is March 31, 2011.

 




 

ACCOMMODATIONS
Deadline June 15, 2011               

Date of arrival:

      June 2011

Date of departure:

      June/July 2011

I wish to book a hotel room:

    No           Yes  

Room:

    Single  
    Twin               Shared with:  

Accompanying person(s):

    number of accompanying persons: 

 




 

PAYMENT INFORMATION
  
The institution paying for the participant:  
Street address:  
City:  
State/Province:  
Zip/Postal Code:  
Country:  
NIP (VATIN):  
Invoice language:  

 




 


I need an invitation letter

    Yes           No  
Conference T-Shirt: