Registration form
Nano in Belgium Workshop
22 October 2015
Room Storck, FPS Employment, Labour and Social Dialogue
1, Ernest Blerotstreet, 1070 Brussels
Please complete this form and send it to nanoevents@environment.belgium.be before:
First registration (for oral presentations): 1 September 2015
Final registration (also for posters): 21 September 2015
Note: this event is free of charge.
Title*:
First Name:
Family name:
Affiliation:
Address:
Zip-code:
City:
Country:
Phone:
e-mail address:
Prof./Dr./Dr Ir./Ir./ Mrs./Mr
Oral presentation*:
Poster presentation*:
Yes/No
Yes/No
Instructions for oral/poster presentations: see pg. 2
*choose one.
1
Application for oral or poster presentations
Please provide the organizers with below mentioned details and submit a short summary of your work:
Presentation (choose): oral/poster
Title of the oral presentation/poster:
Authors:
Name of the presenter:
Title (Prof. /Dr. /Dr. Ir./ Ir/ Mrs. / Mr.):
Affiliation(s):
Contact e-mail address:
Summary/abstract: (not longer than 200 words)
2