The international conference 'Mathematical modeling and differential equations'
The international conference
Brest
17-22 September 2012

APPLICATION FORM
for participation in the 3d Conference
Mathematical Modeling and Differential Equations
Brest, September 17-22, 2012

To take part in the Conference, please, send to the Conference address Kozlovskaja@bsu.by an application in accordance with the next form till 31.01.2012
  1. Family name
  2. First name
  3. Second name
  4. Family name in Roman letters
  5. First name in Roman letters
  6. Сitizenship
  7. Place of employment
  8. Position
  9. Academic degree
  10. Title and prospective time-limit of presentation
  11. Title and prospective number of pages of article
  12. Address:
    • Zip code
    • Country
    • City
    • Street
    • House number
    • Office (flat) number
    • Phone
    • Fax
    • E-mail
  13. Hotel requirement:
    • yes
    • no