ON-LINE REGISTRATION FORM

(Fields marked with * are optional)
 
International course and conference MIND AND BRAIN V: Physics and the Brain
September 17-23, 2006, Dubrovnik, Croatia
 
PARTICIPANT, MAILING ADDRESS
 
Title/Degree:
First name:
Family name:
Institution:
Street address:
Postcode/Zip code:
City:
Country:
Phone:
Fax:
E-mail:
E-mail confirmation:
 
REGISTRATION
 
Registration fee:
  Before June 25 , 2006 Before July 15 , 2006 After July 15 , 2006
Regular 500 EUR 600 EUR 650 EUR
Student 370 EUR 400 EUR 450 EUR
Exhibitor 600 EUR 700 EUR 800 EUR
Accompanying person 250 EUR
Invited lecturer
No fee
 
Registration fee payment : credit card bank transfer no fee
 
Registration fee includes FREE :
Welcome reception: yes no
Guided City tour: yes no
Excursion with banquet dinner: yes no
Lunches - indicate dietary restrictions/preferences:
 
ABSTRACTS
 
I intend to submit an abstract: yes no
*Field(s) of interest/study/research:
*Comments:

 

*FELLOWSHIP and AWARDS APPLICATIONS
   
*Citizenship:
*Date of birth (dd/mm/yyyy):
*Fellowship application : IUC-MZOS IBRO CRO Parliament
*Name of supervisor supporting fellowship application :
*E-mail of supervisor:
*Nikola Tesla Young Scientist Award application : yes no
*Additional remarks:
 

NOTE :
Please check FELLOWSHIP and PROGRAM information for deadlines and additional material required for the fellowship and awards applications.