Registration form - QS'06

Name:

Surname:

Institution:

Mailing Address:

Accompanying person(s)
(name(s)):

Zip Code:

City:

Country:

E-mail:

Phone:

Fax:

I would like to give a general (40 min) talk

I would like to give a (20 min) talk

I wish to present a poster

(Tentative) title of your presentation:

I wish to organize a workshop

If yes,

subject of the workshop:

I apply for the reduced price (e.g. students)

Additional comments/remarks/notes: