Registration form

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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 [email protected] 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
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