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همایش بین المللی پژوهش های ایران

Application Form

 

Country ………………………………..…………………………………………………………………..

 

Surname and Family Name ………………………………………………………………………..

 

Affiliation ………………………………………………………………………………………….

 

Faculty …………………………………………………………………………………………….

 

City ………………………………………………………………………………………………..

 

Street ………………………………………………………………………………………………

 

Postal Code / Zip Code …………………………………………………………………………….

 

Phone No …………………………………   Fax No ………………………………………………

 

E-mail ……………………………………………………………………………………………..

 

General field of interest …….………………………….…………………………………………….

 

Current research and projects: …………………………………………………………………….

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

 

SHORT BIOGRAPHICAL INFORMATION (150-200 words):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAPER ABSTRACT

 

DEADLINE: 15 November 2012

 

One copy of the completed Single Paper Abstract form should be submitted with a copy of the Application Form to powerofidentity@uw.edu.pl  “Forms”.

Incomplete abstract forms will be returned to presenters.

 

PAPER TITLE: _________________________________________________________________

 

 

PAPER PRESENTER

 

Name:________________________________________________________________

 

Affiliation:__________________________________________________________________________

 

Address:___________________________________________________________________________

 

Phone:_______________________________________

 

Fax: _________________________________________

 

E-mail:_____________________________________________________________________________

 

 

ABSTRACT (250-500 words):

 

 

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