Registration for Low x Workshop
(local participants, no Accommodation)

Contact Information:

1) Personal data:

Title*: 

First Name*: 

Last Name*: 

Institution*: 

2) Name and Institution to appear on your badge (if different from above):

Name: 

Institution: 

3) Mailing Address:

E-mail*: 

Private/Mobile Phone (optional): 

Lunches

Lunches will be served in the nearby restaurant Chimera.

I would like to have lunches on the following days*:
 

Date:	How many:
Wednesday, June 27	* ** select number ** (0) no lunches 1 2 3
Thursday, June 28	* ** select number ** (0) no lunches 1 2 3
Friday, June 29	* ** select number ** (0) no lunches 1 2 3
Saturday, June 30	* ** select number ** (0) no lunches 1 2 3

Conference Dinner

Conference Dinner will be on Thursday, June 28 and is included in the conference fee.

1) I am not going to take part in the Conference Dinner*........................

2) I shall take part in the Conference Dinner (default selection).................

Cost of the conference dinner for an accompanying person will be PLN 100.

3) Number of accompanying persons taking part in the Conference Dinner*........... ** select number ** (0) no accompanying persons 1 accompanying person 2 accompanying persons 3 accompanying persons

Special needs

1) Do you need official invitation for example for visa or travel reimbursement?

2) Special dietary needs: