Name:                          

Initials:                             Title:

Company/Organisation:

Department:                 

Postal Address:             City:

Zip/Postcode:                 Country:

Fax:                                 Telephone:

E-mail address:               

Wishes to participate in the s-PolyMat 2012

I am interested in presenting  a: poster

                         or contributed lecture ,

with the title:

I will send a one page abstract before, February 15, 2012.

Registration fee € 395 (payment before 15-01-2012)     

Registration fee € 450 (payment after 15-01-2012) 

Accompanying non scientific participant ( fee € 200)  name: