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\centerline{\large\bf Conference } \s

 \centerline{\Large\bf
Formal and Analytic Solutions  of Differential and Difference Equations
 } \s\s\s





 \centerline{\large Bedlewo, August 8--13, 2011 }\s

 %\centerline{\large\bf  Mathematical Research and Conference Center, B\c edlewo}


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\centerline{\Large\bf Registration Form} \centerline{(to be filled
in and sent back till May 30, 2011)}

\vskip 10pt

NAME:

SURNAME:

SEX:

AGE: (if you apply for financial support)

NATIONALITY:

POSITION:

AFFILIATION: (short, to put on the Conference badge):

E-MAIL ADDRESS:

POSTAL ADDRESS:

TELEPHONE:

FAX:

Remarks/wishes:

Do you need Polish visa? Yes, No

If Yes please let us know the data to be included in the official invitation

Do you wish to present a contribution? Yes, No

Title of your proposed contribution (TeX style):{\bf    }


Abstract:









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