III Ukrainian-Polish Conference

„MEMBRANE AND SORPTION PROCESSES AND TECHNOLOGIES”

 

REGISTRATION FORM

12-1December, 2017, Kyiv, Ukraine

 

Registration formto be submitted to the organizing committee before November 27, 2017

 

Title:         Prof.          As. Prof.         Dr.        PhD student       Master student   

 

Family name:..............................................................................................................

 

First name:..................................................................................................................

 

Institution:...................................................................................................................

 

Position:......................................................................................................................

 

Mailing address:.........................................................................................................

 

Postal code and city:...................................................................................................

 

Country:......................................................................................................................

 

Phone number:.......................................:....................................................................

 

E-mail:........................................................................................................................

 

Application for a presentation:                yes:                         no: 

If yes, please specify:

      -  oral presentation 25 min ,

-        oral presentation 15 min ,

-         poster 

 

Title of report: ......................................................

Co-authors (Names and affiliations):

1.      ..............................................

2.      ..............................................

3.      ..............................................

 

Request for an official invitation letter::       yes:                 no: 

 

Date ....................