FOUR   SEAS     CONFERENCE   in   IASI (Romania)

Alexander Ion CUZA University, May 29- June 3, 2007

APPLICATION     FORM

Your personal data :
Title:                            : Prof. : Dr.    : Student

Family Name   :                Given  Name:

Are You :                      : Male  : Female   

Nationality :               (passport)        Date of Birth:  

Institution :                         City:          

Position held:                                             Since:               

Your postmail address :   

City :                          

Postcode:                          Country:

Telephone :                    FAX :

E-mail address:        (Compulsory : it is the easiest way to join you)

 


Travel :

How do you plan to come in Iasi:                   : by plane              : by train                : by bus

  : by car and I intend to travel with other participants. My travel will be of about  Kms (including return)

(Before buying any ticket, wait the secretariat   instructions which will give you the limits of  travel reimbursement in your case)


Registration :

Important note : accommodation will be provided to students in  two- bed bedrooms at "GAUDEAMUS HOSTEL"  where toilets, bathroom and living room will be shared between 2 persons. In case you prefer an individual flat (i.e. not shared), if available, you will have to pay for the accommodation of two persons  (minimum). Lecturers could have
accommodation in neighbouring hostels
   yes, I apply for individual full participation including lunches and accommodation (cost: 450 Euro)
   yes, I apply for full participation including lunches and accommodation for a couple (cost: 650 Euro)
   yes, I apply for minimal participation without lunches and accommodation (cost: 90 Euro)
   yes, I apply as South-Eastern Europe participant with lunches and accommodation in a shared room. After acceptation,
	by the committee, I will send to the secretariat a traveller cheque of 30 Euro (or 40 $) by post mail

 Arrival date (write 28 or 29):  May  - Departure date (write 2  or 3) June, 2007
(if I have to share a room, I would like to share it, if possible,  with )
Please verify that the form is OK before sending it (click on the "Send Form" Button to send) !


How to verify that your application form was correctly sent :

After submission of the form, you normally receive a warning saying that your e-mail address  will be revealed to the receiver... click OK, and then "document done" appears . 

In that case only  it is OK ! If not, use the following backup solution :

If you have problem sending the form automatically, Click here to copy the Form and paste it in the following e-mail : PSF