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subject=Registration type|*2|maillist|elena@biph.kiev.ua=New registration|elena@serv.biph.kiev.ua=Changes for previous registration 1 |2|note|<h2>1. PARTICIPANT</h2> rank=Title |*|list|Dr.|Miss|Mr|Mrs|Prof. 1.1 ||EMPTYTD First name |* Last name |* position=Position/Job Title| Organization|* Address|*2 line 2|2 city=Town/City |* state=State/County| postal=Postal/Zip Code|* Country|*|list|?|{{CountryList}} phone=Telephone Number (including international and area codes)||phone fax=Fax Number (including international and area codes)||phone Email |*|email 1.2 ||EMPTYTD Arrival Date| Departure Date| 2 |2|note|<h2>2. ACCOMPANYING PERSON(S)</h2>First, please check the box and then enter the last and first name of the accompanying person(s). ln1=1) Last Name| fn1=First Name| ln2=2) Last Name| fn2=First Name| ln3=3) Last Name| fn3=First Name| 3 |2|note|<h2>3. REGISTRATION FEE</h2>The registration fee covers the abstract book, Neurophysiology Issue (Proceedings of IASN) and admission to the scientific sessions, coffee breaks and welcome reception. Scholars will be also provided by Theoretical and Practical Materials for Scholarships. 3.1 |2|note|<font color=red>Late registration (after 15 August 2004) Registrant: USD 25(45) / Student: USD 15(25) / Guest: USD 15</font> 4 |2|note|<h2>4. PAYMENT</h2> Payment|*2|radio|bank=I will arrange a bank transfer in USD on receipt of an invoice|cash=I will pay by cash at site|grant=I have submitted documents for Scholarship 4.1 |2|note|==Banking Details for USD payments==\non a favor of '''Bogomoletz Institute of Physiology''',\n:address: Bogomoletz str,4, 01024 Kiev, Ukraine\n:Account number #2600601283721, MFO 322313, code 05417093\n:The State Export-Import Bank of Ukraine\n:bank address: Kiev Branch, Gorkogo str, 127, 01006\n\nSWIFT: EXPSUAUX, CHIPS UID: 316282 ''(for USA dollars payment only)''\n:Bank Correspondent:\n:Bank Brussels Lambert, Brussels, Belgium\n:SWIFT: BBRU BE BB, cor. Acc.: BEF 301-0188937-62/001\n:''Re: Registration Fee IASN, your Name'' 5 |2|note|<h2>5. SCOLARSHIP</h2>Eligible participants can apply for the funded support covering training course, conference registration, travel or accommodation costs. For eligibility rules see this page.<br/>''Please check the box if you will apply for support'' Scholarship |*2|radio|Application for partial or full IASN scholarship|partial=Application for partial Bogomoletz Scheme support 6 |2|note|<h2>6. ABSTRACT</h2> abtitle=Title |*2 autors=Autors & affiliations |*2|text abstract=Text |*2|text

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