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===   REGISTRATION FORM FOR SUMMER SCHOOL AND WORKSHOP ====
===       BANACH CENTER, BEDLEWO, JULY 2008            ====
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Last name:

First & middle names:

Nationality:

Gender:

Academic affiliation:

Academic position:

Do you need a visa to enter Poland?

E-Mail:

Telephone:

Fax (optional):

Postal address:





Number of accompanying persons:
(For lecturers  in the Summer School and invited speakers in the Workshop)

City of arrival by plane (Warsaw, Berlin or Poznan)
(To possibly arrange group transportation to Bedlewo):

Date of arrival to Bedlewo:

Date of departure from Bedlewo:

Would you like to give a talk at the workshop?

If yes, title and abstract of your proposed talk.

Special requests (e.g. vegetarian food):

The majority   of rooms are double.
Ph.D. students and post-docs will be as a rule  housed in double rooms.
We will make an effort to accommodate  invited  and other senior participants  in singe rooms.

In case there are not enough single rooms do you agree to share a room?

Do you have a preference for a roommate?

ATTENTION: Please mark here if you are NOT applying for any financial support: