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RETURN CARD RETURN CARD RETURN CARD XXVI Conference on Supervising and Diagnostics of Machining Systems Karpacz, 16th - 19th March 2015, POLAND (To be returned as soon as possible – not later than 13th FEBRUARY, 2015) XXVI Conference on Supervising and Diagnostics of Machining Systems Karpacz, 16th - 19th March 2015, POLAND (To be returned as soon as possible – not later than 13th FEBRUARY, 2015) XXVI Conference on Supervising and Diagnostics of Machining Systems Karpacz, 16th - 19th March 2015, POLAND (To be returned as soon as possible – not later than 13th FEBRUARY, 2015) Title____________________________________ Title____________________________________ Title____________________________________ Family Name_____________________________ Family Name_____________________________ Family Name_____________________________ First Name_______________________________ First Name_______________________________ First Name_______________________________ Affiliation_________________________________ Affiliation_________________________________ Affiliation_________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ Mailing address home Mailing address home Mailing address home office (please tick) office (please tick) office (please tick) ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ Postal code and town_______________________ Postal code and town_______________________ Postal code and town_______________________ Country__________________________________ Country__________________________________ Country__________________________________ Telephone________________________________ Telephone________________________________ Telephone________________________________ Fax_____________________________________ Fax_____________________________________ Fax_____________________________________ E-mail___________________________________ E-mail___________________________________ E-mail___________________________________ ________________________________________ ________________________________________ ________________________________________ I plan to contribute a paper I plan to contribute a paper I plan to contribute a paper Yes No Yes No Yes No Tentative title______________________________ Tentative title______________________________ Tentative title______________________________ _________________________________________ _________________________________________ _________________________________________ My method of fee payment: □ bank transfer to: Bank Zachodni WBK S.A. Wroclaw, Poland Account No (IBAN): PL 37109024020000000610000434 SWIFT code: WBKPPLPP Beneficiary’s name: Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw Please put remittance information: HEM Conference (Jedrzejewski), first name and second name. The final date for the transfer is 13th February 2015. My method of fee payment: □ bank transfer to: Bank Zachodni WBK S.A. Wroclaw, Poland Account No (IBAN): PL 37109024020000000610000434 SWIFT code: WBKPPLPP Beneficiary’s name: Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw Please put remittance information: HEM Conference (Jedrzejewski), first name and second name. The final date for the transfer is 13th February 2015. My method of fee payment: □ bank transfer to: Bank Zachodni WBK S.A. Wroclaw, Poland Account No (IBAN): PL 37109024020000000610000434 SWIFT code: WBKPPLPP Beneficiary’s name: Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw Please put remittance information: HEM Conference (Jedrzejewski), first name and second name. The final date for the transfer is 13th February 2015. □ in cash (PLN only) during the Conference □ in cash (PLN only) during the Conference □ in cash (PLN only) during the Conference I suggest that you send Call for Papers to the following person (s) (full name and address): I suggest that you send Call for Papers to the following person (s) (full name and address): I suggest that you send Call for Papers to the following person (s) (full name and address): _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ I enclose the abstract on a separate sheet. I enclose the abstract on a separate sheet. I enclose the abstract on a separate sheet. Signature XXVI Conference (HEM) Wroclaw University of Technology ul. Wybrzeze Wyspianskiego 27 50-370 Wroclaw, POLAND Professor Jerzy Jedrzejewski Signature XXVI Conference (HEM) Wroclaw University of Technology ul. Wybrzeze Wyspianskiego 27 50-370 Wroclaw, POLAND Professor Jerzy Jedrzejewski Signature XXVI Conference (HEM) Wroclaw University of Technology ul. Wybrzeze Wyspianskiego 27 50-370 Wroclaw, POLAND Professor Jerzy Jedrzejewski Tel. (+48 71) 3202703 Tel. (+48 71) 3202703 Tel. (+48 71) 3202703 Fax ( +48 71) 3202703 Fax ( +48 71) 3202703 Fax ( +48 71) 3202703 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected]
