Name, surname___________________________________________________

Scientific (academic) degree_________________________________________

Place of work, position______________________________________________

The work group chosen_____________________________________________

Theme of report ___________________________________________________

Short annotation of the report (about 500 symbols) ______________________

Address: _________________________________________________________

Phone:___________________________________________________________

Fax:_____________________________________________________________

E-mail address: ________________

Is a hotel room necessary?

(indicate date of arrival and departure)

necessary ________

unnecessary _______