Application form

Deadline for submitting the application is prolonged till April 10, 2011

NOTE * Participants from the former USSR countries have to write their names, living address and correspondence address (fields 1.1, 1.2, 1.3, 1.8 and 1.9 (marked with asterisk) in Russian (or Ukrainian if they are citizens of Ukraine))

All fields have to be filled in!

1. PERSONAL INFORMATION
1.1. First name *
1.2. Last name *
1.3. Other names you are known by *
1.4. Date of birth (DD/MM/YY)
1.5. Gender	male female
1.6. Citizenship
1.7. Country of residence
1.8. Living address (including city, street, house and apartment number) *
1.9. Correspondence address (including postal code, city, street, house and apartment number) *
1.10. Phone number, mobile
1.11. E-Mail
1.12. Educational establishment (university, institute) or organization you represent
1.13. Department at which you study, work and year you are currently in
1.14. If you represent an organization, please indicate your post there
1.15 How good is your English?	fluent meduim low I don’t speak English but I do wish to participate
1.16. Insert here your picture (max 100 kb, JPEG, GIF and PNG are allowed)
2. CONFERENCE PREFERENCES
2.1. What is the topic of your theses?
Please attach your theses here (doc, docx, odf or txt file)
2.2. Which workshop have you chosen? (from the information list)
2.3. Do you wish to speak at the plenary session or work shop?
2.4. What equipment do you need for your presentation?	Multimedia Overhear projector Slider
2.5. Do you wish to give a lecture on a topic different from that of your theses? (if yes, give an outline of the lecture contents, max 200 words)
2.6. Please, give your experience in tackling environmental issues (involvement in projects, etc. limit yourself to max 200 words)
2.7. What contribution could you make to the cultural program (national costumes, singing, national food, etc)
2.8. Indicate a source from which you received information about the conference?
2.9. Is it your first time at “economics for ecology”?	yes no