APPLICATION FORM FOR SYMPOSIUM

APPLICATION FORM FOR SYMPOSIUM/ SEMPOZYUM BAŞVURU FORMU
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Name Surname/ Ad Soyad: ……………………………………………………………………
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Job and Job Title/ Mesleği ve Görevi:
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The name of the Company-University-Institution/ Firma- Kurum:
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Mail Address/ Posta Adresi:
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• Phone/ Telefon: …………………………
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• Fax / Faks:
• e-mail/ e-posta: ………………………………………………………………………
( ) Participation without presentation/ Dinleyici olarak katılmak istiyorum.
( ) Participation with presentation (Oral/Poster)/ Bildiri ile katılmak istiyorum. (Poster / Sözlü)
Abstract Title/ Bildiri Konu Başlığı: …………………………………………………………
Participation of workshop/ Çalıştay’a Katılım
( ) Participation as a visitor / Dinleyici olarak katılmak istiyorum
( ) I wish to participate as a lecturer in …………………………../ ……………………..konusunda
Eğitimci olarak katılmak istiyorum.
( ) Participation in Brokerage Event/ Proje Pazarı’na Katılım
( ) Participation as a sponsor/ Sponsor olmak istiyorum.
( ) I would like to give advertisement/ Reklam vermek istiyorum.
( ) Participation in the exhibition/ Kuruluş olarak sergiye katılmak istiyorum.
Your recommendations regarding workshop, brokerage event topics and other issues/
Çalıştay ve diğer konulardaki
önerileriniz :..……….……………………………………………………………………………
……………………………………………………………………………….…………………
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Date/ Tarih :
Signature/ İmza:
Note: Please return this form to the Symposium Secretariat. / Lütfen bu formu Sempozyum
Sekreterliği’ne iletiniz.
Symposium Secretariat
UCTEA Chamber of Chemical Engineers
Aegean Branch Office
TMMOB Kimya Mühendisleri Odası
Ege Bölge Şubesi
Tel: 0 232 421 3535 Faks: 0 232 459 0869
www.kmoetkinlik.org
e-mail: composite@kmoetkinlik.org

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