Registration for PhandTA 9
9th International Conference 
on Pharmacy and Applied Physical Chemistry
 

  Last Name
  First Name
Title
Company / Institute
  Address
  City
  Zip
  Country
  Phone
  Fax
  E-Mail
     
  I will be accompanied by   persons.
  Name(s)
  I intend to present a contribution Yes         No
  Title
  Author(s)
  Preferred Poster         Lecture         On Scientific Committee decision
   
Payment by Bank Transfer: A bill will be sent within 3 weeks after registration.
For payment by credit card, please use the Fax form available at the website.

If required, a printout of this form needs to be done before submission.