RegistratioN FORM

DM MEETS NANO

Arne Nováka 1, 602 000 Brno

dmmeetsnano@gmail.com

https://sites.google.com/view/
dm-meets-nano

+420 722 903 110
RegistratioN FORM
Full Name*

First NameLast Name
Email*
example@example.com
Affiliation*
When are you planning to attend the conference?*

Tue 07 JulyWed 08 JulyThu 09 JulyAll days
Will you join us for the conference dinner, 08 July?*

YesNo
If you are joining, do you have any food allergies/dietary requirements?*
Conference fee
We ask a small conference fee of 25 EUR this year.

Please transfer the fee by 1 July to the following account "Anne-Li Demonie, BE61 6507 2960 3917 (BIC: REVOBEB2)" and use the note LAST NAME + DMMEETSNANO.
I have taken note of the conference fee and intend to pay it by the due date:*

YesNo
Do you have any further comments?
Should be Empty:

Conference fee