REGISTRATION

Registration form:

THE XIV CONFERENCE ON APPLIED AND INDUSTRIAL MATHEMATICS,
dedicated to the 60th anniversary of the foundation of the Faculty of Mathematics and Computer Science of  Moldova State University.

1. Name, Family name __________________________________________
2. Affiliation (complete), country __________________________________
_____________________________________________________________
3. Position ____________________________________________________
4. Academic degree, title ________________________________________
5. Post Address ________________________________________________
_____________________________________________________________
6. Telephone for contact, fax  ____________________________________
7. E-mail _____________________________________________________
8. Section_____________________________________________________
9. Title of communication ________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
10. Co-authors (Name, Family name) ______________________________
_____________________________________________________________
_____________________________________________________________

11.     Hotel reservation

   Hotel **   ( ~ 20 – 40 euro)             from ______ to _________
   Hotel *** ( ~ 40 – 60 euro)             from ______ to _________
   Student hotel  (~ 2 – 5 euro)           from ______ to _________

Date                                                       Signature

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