SECOND WORKSHOP ON NONLINEARITY & GEOMETRY. DARBOUX DAYS.

REGISTRATION  FORM

(to be filled in and sent back till February 20, 2008)

Last name:
First name:
Middle name:

Title/Position:

Email:
Telephone:

Organization:
Address:
Postal code:
City:
Country:

Arrival Date:
Departure Date:

Do you need Polish visa?  Yes/No

Do you need support to cover local expenses?  Yes/No

Accompanying person:   Yes/No

Vegetarian food:    No/Yes
Other requests:

Proposed talk        Yes/No
Poster               Yes/No

Abstract: