ISSRNS 2019 registration form

ISSRNS 2019 registration

FIRST NAME

MIDDLE NAME

LAST NAME

GENDER

Male Female

TITLE

Prof. Dr. PhD student Undergraduate student Other

E-MAIL

PHONE

INSTITUTE NAME

DEPARTMENT NAME

STREET ADDRESS

CITY

ZIP CODE

COUNTRY

FORM OF PRESENTATION

Invited lecture Oral presentation Poster

PRESENTATION TITLE

DO YOU PARTICIPATE IN STUDENT AWARD POSTER COMPETITION?

Yes No

TYPE OF ABSTRACT

Abstract Extended abstract (more than two pages)

WILL YOU SUBMIT FOR PUBLISHING IN ISSRNS 2019 (NIMB) PROCEEDINGS?

Yes No

ACCOMODATION (limited number of single rooms available)

Single room 2-bed room

ACCOMMODATION PREFERENCES (e.g. room sharing)

EXTRA INFORMATION (diet, allergies), SUGGESTIONS

PAYMENT

Credit card Bank transfer

ARRIVAL DATE(dd-mm-yyyy)

DEPARTURE DATE(dd-mm-yyyy)

INVOICE REQUIRED?

Yes No

INSTITUTIONAL DATA FOR INVOICE [skip if NO has been selected above]

INVOICE DESCRIPTION [skip if NO has been selected above]

You agree for personal data processing (PDA) by Polish Synchrotron Radiation Society. Providing data is voluntary, but if you don't provide it, it won't be possible for you to register for the Event organized by the PDA. See PDA information.