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19th Int. Workshop on Differential Geometric Methods in Theoretical Mechanics
Będlewo (POLAND), August 22-29, 2004

(Registration form)

First name and family name:
Affiliation:
e-mail:
Request accomodation:
	From August : To August :
Accompanying persons:	YES NO
I volunteer to share a room	YES NO,
if necessary, with:

I wish to present a short communication (30 min. maximum): YES NO
If Yes, please give a tentative title:


Other relevant information (special food, small children, ...):

I need a financial support:	YES NO
I wish to use the bus to Prague:	YES NO

Comments and suggestions: