| Full Name * : | |
| Scientific degree and title * : | |
| Place of work and job position * : | |
| Organization * : | |
| Correspondence address: | |
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| E-mail * : | |
| Topic: |
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| Author/s/: | |
| Participation with: |
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| Accommodation: | |
| Dates: | |
| Single/Double room: |
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| Massage to the organization: |
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