Registration FORM(ulaire) d'enregistrement "GeoSeminar DIMITRIE CANTEMIR", 13-15 Oct 2017 Iași-Romania
Nous vous prions de compléter les espaces vides et appuyez ENVOYER / Please fill in the blanks and press SUBMIT
Email address
1.Votre Nom / Your Surname
Your answer
2.Votre Prénom / Your First Name.
Your answer
Sex / Sexe
3.Adresse EMAIL / Address
vérifier l'ortographe / please verify spelling
Your answer
4.Reinsérez l'adresse EMAIL / Please reinsert EMAIL address
Your answer
5.Telephone de Contact / Tel Number (Ex. 39 7232090902)
Preférablement portable avec prefixe pays / preferably mobile - including country code / prefix RO 40 si numar (DO NOT ADD ”+”).
Your answer
6.Rang / Rank
(exemple/i.e. ”Professor Phd/Dr, Associate Prof., PhD Student, Master/Bachelor student, Researcher/Rechercheur)
Your answer
7.Votre Institution / Your Home Institution
University / Institute / Administration etc.
Your answer
8.Votre PAYS d'origine et VILLE / Your COUNTRY of origin and CITY.
(exemple / i.e.: NORWAY, OSLO)
Your answer
9.TITRE de la présentation / TITLE of your presentation
Your answer
10.Auteur(s) / Author(s) in order. Example: Assist. dr. SMITH John, PhD Stud. POPESCU Maria
Rang, NOM (maj), Prenom / Rank, SURNAME (capital letters), First name
Your answer
11.Mots-clefs / Keywords
max. 5
Your answer
12.Résumé de la présentation / ABSTRACT of your presentation (min. 1000, max. 4000 char.)
Encoller ici votre Résumé / please paste here your abstract
Your answer
14.Cochez la section désirée / Please tick the desired section
Cochez "other" si vous desirez de proposer une nouvelle section / Please tick "other" if you would like to propose a new section
15.Forme de presentation / Type of presentation
Required
16.Voulez vous participer a l'excursion en car (dimanche) / Would you like to participate to our Field trip (Sunday)
Car/Bus (Dim/SUN 15 OCT, 08.00h - 22:30h) - Republique de Moldavie / Republic of Moldova - (Chisinau, Cricova Winery, Capriana), coût/cost 240 LEI (~60 €)
17.Cochez les activités désirées / Please tick the desired activities
Required
18.Avez vous besoin d'une Attestation de Participation? Do you need a Certificate of Attendance?
Il sera disponible au jour de votre arrivée. Envoyez un message a seminar_cantemir@yahoo.com si vous avez besoin d'invitation pour obtenir le visa / it will be ready upon your arrival. Please send us an email et seminar_cantemir@yahoo.com if you need an invitation for your visa.
19.(seulement pour les invites internationnaux / Only for international guests) Avez vous besoin d'hebergement / Do you need accommodation?
..
20.Autres observations regardant votre arrivee ou sejour / Other observations concerning your arrival or stay
optional. Ex: special needs, vegetarian etc.
Your answer
A copy of your responses will be emailed to the address you provided.
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