Website Registration Form

19th International Colloquium on Animal Cytogenetics and Gene Mapping
National Research Institute of Animal Production
June, 6-9, 2010, Kraków-Balice, Poland

Please fill in your details below. Note that, entries with asterisks have to be obligatorily filled in. Persons who have sent “Preliminary Participant Registration Form” are asked to provide only entries with two asterisks. Everyone who fills in the registration form for the first time is asked to provide entries marked with both one and two asterisks.

Mr. Mrs **

Surname**: First name**: Degree**: Student MSc PhD student PhD Prof

Institution*:		Department*:
Country*:	lista panstw	Zip code*:
Address*:
Phone*:		Fax*:
E-mail*:

Abstract tittle**:

Accompanying person:

Special requests regarding meals:

Vegetarian food

Other requests or allergy to

Registration fee **

	March 31th, 2010	Social Dinner	Excursion (Wieliczka Salt Mine)
Participant	Before 250 € , After 300 €	50 €	50 €
Student/PhD student	Before 200 € , After 250 €	50 €	50 €
Accompanying person	150 €	50 €	50 €
Total:	€

 

Invoice data (if different than indicated above):

Institution:
Country:	lista panstw	Zip code:
Address:

Arrival date*

2010-June- 1 2 3 4 5 6 7 8 9

Departure date*

2010-June 6 7 8 9 10 11 12

Comments:

NATIONAL RESEARCH INSTITUTE OF ANIMAL PRODUCTION
Department of Animal Immuno- and Cytogenetics

32-083 Balice ul. Krakowska 1, phone +48 666 081 326, fax: +48 12 285 6733, e-mail: eslota@izoo.krakow.pl