ࡱ;   !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRTUVWXYZ[\]^_`abcdefgijklmnopqrstuvwxyz{|}~Root Entry FWordDocument&Data S)1TablehE#` 0bjbjmm&,0008(1|1\,LAn 3 3 3 3 3&5&5&5@@@@@@@$Bh"Ez@M75""5M7M7@ 3 3A_;_;_;M7| 3 3@_;M7@_;_;_; 33 @07|_;g<dA0LA_;EE8E_;w;E;&5Z5@_;545Y&5&5&5@@;X&5&5&5LAM7M7M7M7,,,0,,,0,,  APPLICATION FORM 8th International Congress of Young Chemists YoungChem 2010 6-10 October, Reda, Poland Please provide us with the following information: 1 Surname2 Name(s)3 Sex[ ] male, [ ] female4 Status[ ] student, [ ] PhD student, [ ] Other (specify): 5a) Full name of organisation (English)5b) Full name of organisation (native)6a) Faculty (English)6b) Faculty (native)7 Address8 City / Zip code / Country9 Title of presentation10 Scientific trend of presentation[ ] Biotechnology and Biochemistry [ ] Analytical 91AV [ ] Advanced Materials and Nanotechnology [ ] Organometallic 91AV [ ] Environmental 91AV [ ] Organic Synthesis and Catalysis [ ] Physical and Theoretical 91AV [ ] Other (specify): 11 Preferable type of presentation:[ ] oral (own research only!) [ ] poster (own research only!) [ ] oral & poster (cannot concern the same topic!)12 E-mail13 Fax (organisation)14 Phone (mobile)15 Do you need an official invitation for visa? NOTE!: Due to countless "EU" VISA fraud attempts we DO NOT send INVITATION LETTER prior to money transfer.[ ] yes, [ ] noIf yesDirect contact address:Street:Postal code:City:Country:Fax:16Do you need the confirmation of acceptance of charge?[ ] yes, [ ] noIf yesCharge to:Institution:Address: 17Name of accompanying person (if any) NOTE!: Additional charge applies (the conference fee for accompanying person is equal to the normal conference fee).18Do you have special dietary needs?  19Official conference T-Shirt size[ ] S, [ ] M, [ ] L, [ ] XL20Are you interested in sightseeing trip to Gdansk?[ ] Yes, [ ]NoThe collected personal information will not be rent, sold or shared with other people or companies. 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