APPLICATION FORM FOR SYMPOSIUM/ SEMPOZYUM BAŞVURU FORMU • Name Surname/ Ad Soyad: …………………………………………………………………… • Job and Job Title/ Mesleği ve Görevi: ………………………………………………………………… • The name of the Company-University-Institution/ Firma- Kurum: ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ………………………………………………… • Mail Address/ Posta Adresi: ……………………………………………………………………………………………………… ……………………… • Phone/ Telefon: ………………………… ………………………… • 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 :..……….…………………………………………………………………………… ……………………………………………………………………………….………………… ………………………………………………………………………………………………… 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: [email protected]
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