Registration form - ERGO WORK FINAL CONFERENCE

1. REGISTRATION FORM for
THE INTERNATIONAL SCIENTIFIC CONFERENCE
Ergonomics – opportunity
for new human jobs
organized within the ERGO WORK Project funded by European Union
Siedlce University of Natural Sciences and Humanities (Main Library)
9, ks. Jerzego Popiełuszki Street
08-110 SIEDLCE (Poland)
16th September 2015
Name and Surname: ……………………………………………………………………………….
Academic Title/Degree: ……………………………………………………………………………….
Participation with a paper
without a paper
The Title of Presentation: ………………………………………………………………………..........
……………………………………………………………………………….
Language of the Paper English Polish
Place of Employment: ……………………………………………………………………………….
Position: ……………………………………………………………………………….
Mailing Address: ……………………………………………………………………………….
……………………………………………………………………………….
……………………………………………………………………………….
e-mail: ……………………………………………………………………………….
phone, fax: ……………………………………………………………………………….
Faculty of Economic and Legal Sciences
17/19, Żytnia Street, 08-110 Siedlce (Poland)
Secretariat of the Conference:
Marzena Wójcik-Augustyniak
phone: +48 604 253 198
e-mail: marwojaug@tlen.pl