MediaWiki:2009CS-fields

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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.PARTICIPANT

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rank=Title |*|list|Dr.|Miss|Mr|Mrs|Prof.

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1.1 ||EMPTYTD

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First name |*

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Last name |*

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position=Position/Job Title|

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Organization|*

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Address|*2

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line 2|2

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city=Town/City |*

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state=State/County|

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postal=Postal/Zip Code|*

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Country|*|list|?|AF=Afghanistan |AX=Aland Islands|AL=Albania |DZ=Algeria |AS=American Samoa |AD=Andorra |AO=Angola |AI=Anguilla |AQ=Antarctica |AG=Antigua and Barbuda |AR=Argentina |AM=Armenia |AW=Aruba |AU=Australia |AT=Austria |AZ=Azerbaijan |BS=Bahamas |BH=Bahrain |BD=Bangladesh |BB=Barbados |BY=Belarus |BE=Belgium |BZ=Belize |BJ=Benin |BM=Bermuda |BT=Bhutan |BO=Bolivia, Plurinational State of |BA=Bosnia and Herzegovina |BW=Botswana |BV=Bouvet Island |BR=Brazil |IO=British Indian Ocean Territory |BN=Brunei Darussalam |BG=Bulgaria |BF=Burkina Faso |BI=Burundi |KH=Cambodia |CM=Cameroon |CA=Canada |CV=Cape Verde |KY=Cayman Islands |CF=Central African Republic |TD=Chad |CL=Chile |CN=China |CX=Christmas Island |CC=Cocos (Keeling) Islands |CO=Colombia |KM=Comoros |CG=Congo |CD=Congo, the Democratic Republic of the |CK=Cook Islands |CR=Costa Rica |CI=Cote d'Ivoire Côte d'Ivoire |HR=Croatia |CU=Cuba |CY=Cyprus |CZ=Czech Republic |DK=Denmark |DJ=Djibouti |DM=Dominica |DO=Dominican Republic |EC=Ecuador |EG=Egypt |SV=El Salvador |GQ=Equatorial Guinea |ER=Eritrea |EE=Estonia |ET=Ethiopia |FK=Falkland Islands (Malvinas) |FO=Faroe Islands |FJ=Fiji |FI=Finland |FR=France |GF=French Guiana |PF=French Polynesia |TF=French Southern Territories |GA=Gabon |GM=Gambia |GE=Georgia |DE=Germany |GH=Ghana |GI=Gibraltar |GR=Greece |GL=Greenland |GD=Grenada |GP=Guadeloupe |GU=Guam |GT=Guatemala |GG=Guernsey |GN=Guinea |GW=Guinea-Bissau |GY=Guyana |HT=Haiti |HM=Heard Island and McDonald Islands |VA=Holy See (Vatican City State) |HN=Honduras |HK=Hong Kong |HU=Hungary |IS=Iceland |IN=India |ID=Indonesia |IR=Iran, Islamic Republic of |IQ=Iraq |IE=Ireland |IM=Isle of Man |IL=Israel |IT=Italy |JM=Jamaica |JP=Japan |JE=Jersey |JO=Jordan |KZ=Kazakhstan |KE=Kenya |KI=Kiribati |KP=Korea, Democratic People's Republic of |KR=Korea, Republic of |KW=Kuwait |KG=Kyrgyzstan |LA=Lao People's Democratic Republic |LV=Latvia |LB=Lebanon |LS=Lesotho |LR=Liberia |LY=Libyan Arab Jamahiriya |LI=Liechtenstein |LT=Lithuania |LU=Luxembourg |MO=Macao |MK=Macedonia, the former Yugoslav Republic of |MG=Madagascar |MW=Malawi |MY=Malaysia |MV=Maldives |ML=Mali |MT=Malta |MH=Marshall Islands |MQ=Martinique |MR=Mauritania |MU=Mauritius |YT=Mayotte |MX=Mexico |FM=Micronesia, Federated States of |MD=Moldova, Republic of |MC=Monaco |MN=Mongolia |ME=Montenegro |MS=Montserrat |MA=Morocco |MZ=Mozambique |MM=Myanmar |NA=Namibia |NR=Nauru |NP=Nepal |NL=Netherlands |AN=Netherlands Antilles |NC=New Caledonia |NZ=New Zealand |NI=Nicaragua |NE=Niger |NG=Nigeria |NU=Niue |NF=Norfolk Island |MP=Northern Mariana Islands |NO=Norway |OM=Oman |PK=Pakistan |PW=Palau |PS=Palestinian Territory, Occupied |PA=Panama |PG=Papua New Guinea |PY=Paraguay |PE=Peru |PH=Philippines |PN=Pitcairn |PL=Poland |PT=Portugal |PR=Puerto Rico |QA=Qatar |RE=Reunion Réunion |RO=Romania |RU=Russian Federation |RW=Rwanda |BL=Saint Barthélemy |SH=Saint Helena |KN=Saint Kitts and Nevis |LC=Saint Lucia |MF=Saint Martin (French part) |PM=Saint Pierre and Miquelon |VC=Saint Vincent and the Grenadines |WS=Samoa |SM=San Marino |ST=Sao Tome and Principe |SA=Saudi Arabia |SN=Senegal |RS=Serbia |SC=Seychelles |SL=Sierra Leone |SG=Singapore |SK=Slovakia |SI=Slovenia |SB=Solomon Islands |SO=Somalia |ZA=South Africa |GS=South Georgia and the South Sandwich Islands |ES=Spain |LK=Sri Lanka |SD=Sudan |SR=Suriname |SJ=Svalbard and Jan Mayen |SZ=Swaziland |SE=Sweden |CH=Switzerland |SY=Syrian Arab Republic |TW=Taiwan, Province of China |TJ=Tajikistan |TZ=Tanzania, United Republic of |TH=Thailand |TL=Timor-Leste |TG=Togo |TK=Tokelau |TO=Tonga |TT=Trinidad and Tobago |TN=Tunisia |TR=Turkey |TM=Turkmenistan |TC=Turks and Caicos Islands |TV=Tuvalu |UG=Uganda |UA=Ukraine |AE=United Arab Emirates |GB=United Kingdom |US=United States |UM=United States Minor Outlying Islands |UY=Uruguay |UZ=Uzbekistan |VU=Vanuatu |VE=Venezuela, Bolivarian Republic of |VN=Viet Nam |VG=Virgin Islands, British |VI=Virgin Islands, U.S. |WF=Wallis and Futuna |EH=Western Sahara |YE=Yemen |ZM=Zambia |ZW=Zimbabwe

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phone=Telephone Number (including international and area codes)||phone

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fax=Fax Number (including international and area codes)||phone

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Email |*|email

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1.2 ||EMPTYTD

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Arrival Date|

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Departure Date|

2. ACCOMPANYING PERSON(S)

First, please check the box and then enter the last and first name of the accompanying person(s).

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ln1=1) Last Name|

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fn1=First Name|

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ln2=2) Last Name|

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fn2=First Name|

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ln3=3) Last Name|

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fn3=First Name|

3. REGISTRATION FEE

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.

Late registration (after 15 August 2004) Registrant: USD 25(45) / Student: USD 15(25) / Guest: USD 15

4. PAYMENT

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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

Banking Details for USD payments

on a favor of Bogomoletz Institute of Physiology,

address: Bogomoletz str,4, 01024 Kiev, Ukraine

Account number #2600601283721, MFO 322313, code 05417093

The State Export-Import Bank of Ukraine

bank address: Kiev Branch, Gorkogo str, 127, 01006

SWIFT: EXPSUAUX, CHIPS UID: 316282 (for USA dollars payment only)

Bank Correspondent:

Bank Brussels Lambert, Brussels, Belgium

SWIFT: BBRU BE BB, cor. Acc.: BEF 301-0188937-62/001

Re: Registration Fee IASN, your Name

5. SCOLARSHIP

Eligible participants can apply for the funded support covering training course, conference registration, travel or accommodation costs. For eligibility rules see this page.
Please check the box if you will apply for support

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Scholarship |*2|radio|Application for partial or full IASN scholarship|partial=Application for partial Bogomoletz Scheme support

6. ABSTRACT

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abtitle=Title |*2

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autors=Autors & affiliations |*2|text

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abstract=Text |*2|text