Registration form first name, name, title, possition:    



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15th All-Polish Corrosion Symposium (APCS - 2010)

New Achievements in Corrosion Research and Engineering”



Jastrzab-Poraj (Poland), Holiday & Recreation Centre „Lesna Radosc”

24-26th November 2010


REGISTRATION FORM

FIRST NAME, NAME, TITLE, POSSITION: .........................

.........................

INSTITUTE / ORGANISATION, ADDRESS, .........................

.........................

PHONE, FAX: ......................... E-mail address: .........................

I INTEND TO GIVE A PRESENTATION (PLEASE TICK “X” WHERE APPLICABLE) YES  NO 

Tentative title of presentation:
.........................

PREFERRED TYPE OF PRESENTATION: ORAL  POSTER 

I INTEND TO TAKE PART IN EXIBITION (PLEASE TICK “X” WHERE APPLICABLE) YES  NO 

I DECLARE A PAYMENT OF SYMPOSIUM FEE (PLEASE TICK “X” WHERE APPLICABLE):

 PSK Member; double/single room; Non-Member; double/single room;Accompanying person

 student (proof of status must be attached); double room

(The amount of the Symposium fee for early/late registration will be announced in June, 2010 (First Circular). It will cover Symposium Proceedings (volume of No 11/2010 Ochr.przed Korozja), accommodation, full board, refreshments, welcome reception and the beer party)
Bank transfer:

Beneficiary Bank Name: PKO BP S.A. I O/Czestochowa

Account Number: PL65102016640000300201200146

SWITCH Number: BPKOPLPW

Rec.Address: SITPH, Oddz.Hutnictwa Zelaza i Stali - Czestochowa

Message: Poraj-2010 (+ Participant’s name)

.........................



PARTICIPANT’S SIGNATURE

The registration form should be submitted to the Symposium Office by ordinary post or as attachment by e-mail


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