APPLICATION FORM
International Academic Conference
e-methodology
31thMarch-01thApril 2015
University of Wroclaw (Poland)

Please fill this form out on your computer and send it as a .doc file

to the e-mail address:

General information:

First Name:
Last Name:
Country:
University (institution):
Specialization:
Academic degree:
Postal address:
Phone number (including country and region codes):
E-mail:

Information on the paper

1. Primary author (full name)
2. Co-authors (full names, separated by ';')
3. Title
4. Keywords
5. Abstract (max. 150 words).

Form of the presentation at the conference

1P. Form of presentation (mark with an “x”) / Verbal presentation
Poster

In every conference room there will be a computer (with MS Office) and a multimedia projector for the speakers.

The time for the presentation is 15 minutes (there is additional time for questions and discussion outside of this time).

The poster needs to be printed by the participants themselves and brought to the conference.

The maximum size of the poster is A-0.

Regarding dinner and lunches, please mark with an “x” your choice of culinary preference*

Regular
Vegetarian

In case of any other religious or cultural issues regarding the dinner, please let us know.

Invoice for the conference fee (please mark your choice with an “x”)*

I don’t need an invoice.
I need a scan of the proforma invoice (issued before the payment is made) sent to my e-mail adress
I need a printed proforma invoice (issued before the payment is made) sent to my adress
I need a scan of the regular invoice (issued after the payment is made) sent to my e-mail adress.
I need a printed regular invoice (issued after the payment is made) sent to the following adress:
......
I need a printed invoice and I will collect it during the conference

Data for the invoice including post code and VAT number (for institution)

(fill out only if you need an invoice)

If your institution (for instance: university) is paying your fee – you need to put here the data of the institution.

If you are paying yourself – please put here your own data.

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

The invoice will be issued only if you put the data in this form.

Invitation for the conference (necessary for obtaining a visa)

Poland is a member of the European Union and part of the Schengen Area.

If you are not sure whether you need a visa to travel to Poland – please check with the local authorities.

I don’t need an invitation.
I need a scan of the invitation sent to my e-mail adress.
I need a printed invitation sent to the following adress:
......

Conference account in EUR for payments from abroad:
owner Fundacja Pro Scientia Publica
adress ul. Redycka 37, 51-169 Wrocław, POLAND
mBank S.A. FORMERLY BRE BANK S.A. (RETAIL BANKING)
SWIFT CODE: BREXPLPWMUL
IBAN PL 50 1140 2017 0000 4012 0123 9862
noticed for: 'emethodology'
address of the bank: Al. Piłsudskiego 3, 90-368 Łódź

Conference account in zlotys for payment from Poland:
owner Fundacja Pro Scientia Publica
address ul. Redycka 37, 51-169 Wrocław,
BANK: Volkswagen Bank Polska SA

account no: 12 2130 0004 2001 0536 2769 0002

noticed for (tytulem): "dzialalnosc statutowa INT"