5th IOTM - Registration

Preliminary registration form
for the 5th IOTM

I intend to participate in the 5th International Oligochaete Taxonomy Meeting that will take place in Beatenberg, Switzerland, from April 11th to 15th, 2011.

(All details regarding the registration fees are given --> here.)

Please note that fields marked with an * are mandatory.

Salutation Mrs Ms Mr
Academic title
First Name
*Family name
Address (street, zip code, town)
Country
Affiliation
*e-mail address
Website
Number of persons that will accompany me
I would need accommodation in the following category Category A: Single room with shower and toilet Category B: Double room occupancy in room with shower and toilet Category C: Double room occupancy in room with wash basin (shower and toilet on the same floor)
I plan to present an oral communication a poster both
The preliminary title(s) is/are

!!! Please make sure that you correctly spelled your e-mail address!!!

!!! Please do send us also YOUR PICTURE by e-mail for the Delegates page !!!

Please enter the sequence of numbers and letters,
as displayed in the picture below, in the field below this picture
(this is an anti-spam measure):

You can send us these data also directly by e-mail

Preliminary registration form for the 5th IOTM

Please enter the sequence of numbers and letters, as displayed in the picture below, in the field below this picture (this is an anti-spam measure):

Preliminary registration form
for the 5th IOTM

Please enter the sequence of numbers and letters,
as displayed in the picture below, in the field below this picture
(this is an anti-spam measure):