Delegate

Title

First Name

Last Name

Institute

Address

Postal code

Country

Telephone Number

e-mail Address

Arrival date at workshop

Departure date from workshop

Where will you be staying during the Member Workshop?

Will you be presenting a

If presenting a talk, how much time do you need?

If presenting a talk, which media will you be using?

Do you need assistance with transport from the airport between your
accommodation and the Gemeindezentrum Foundation?

Will you be attending the Public Lecture?

Will you be interested in purchasing a commemorative clothing item?
(The aim of these questions is to act only as a survey and not as an order)

Would you prefer a
(all items will be machine embroidered - final designs of all items here)

What size would you prefer?

General comments: