REGISTRATION FORM

ECCI-9

The Academy of Humanities and Economics in Lodz

c/o Prof. PhD Makary Stasiak

ul. Rewolucji 1905r. No 64

Lodz Poland

Phone: 004842 6315806

Fax  : 0048426315888

E-Mail: transformations@wshe.lodz.pl

 

Please fill in the registration form

Name (*)

Surname (*)

Address (*)

Postal code (*)

City (*)

Country (*)

Telephone (*)

E-mail (*)

Passport no. (*)

 

Accommodation

Please choose and indicate:

Hotel "Magellan":

No.of nights

No.of persons:

- single room

90 euro/per day

- double room for one person

90 euro/per day

- double room for two persons

100 euro/per day

- room for three persons

120 euro/per day

Hotel "Molo":

- double room

25 euro/per day

"Molo" offers transport to the Magellan Conference Center after breakfast and dinner each day.

   

Tick if yes

Cost of transport to the Conefernce Center Magellan 30 euro overall after breakfast and dinner each day :

30 euro overall


Personal details of accompanying person:

Name

Surname

E-mail

Passport no.

   

Tick if yes

Programme for Accompanying Person:

600 euro overall

Indicate any special dietary needs:


Please inform us of your arrival time - we offer transport from Okęcie Airport in Warsaw to the Conefernce Center "Magellan" in Bronisławów and the hotel "Molo" according to a schedule the organizers will deliver in the proceeding conference materials.


     
   

Tick if yes

 

Cost of transport from the airport to the hotels:

25 euro/one way

From the airport

To the airport

Arrival date:

September 2005

Flight No.

Time of arrival:


REGISTRATION FORM: ACADEMIC PAPERS

Please fill in the registration form for academic papers:

Paper's title:

Last Name:

First Name:

Degree:

First author's

Second author's

Third author's

 

To whom the acknowledgement and assignment of the paper will be sent:

 

Family Name

First Name

Degree

Institution/Company

Department

Address

City

Post Code

Country

Phone

Fax

E-mail

Please indicate the category of your academic paper:

30-minute sessions:

60-minute workshops (exceptional-after approval of the board for academic papers):

Key-words of your paper:

Key objectives your paper :

Review board for your academic paper:

Prof. PhD Jan Buijs -The Netherlands

Prof. PhD Olaf Fisscher - The Netherlands

Mr. Han van der Meer-The Netherlands

Prof. PhD Makary Stasiak -Poland

Do not forget to send the abstract of your paper:
- 250 words (or 1600 signs) for 30-minute sessions
- 500 words (or 3200 signs) for 45- and 60-minute sessions

 

Theme Groups : please choose the one you would like to attend and indicate:

Spiritueality and Leadership by Alex Jaccaci

Subject centered leadership by Makary Stasiak

Creativity through art by Wiesław Karolak

Transformation in practice by KREANET members

Four families of tools and techniques of creativity Colette by Chambon and Guy Aznar

Conference fee before August 20 th - 800 euro

Conference fee after August 20 th - 850 euro

Transfer money to: IBAN PL 93 1060 0076 0000 4099 6003 4687 SWIFT BPH PL PK


 

 

    
       


REGISTRATION FORM: ADDITIONAL TOURS

PARTICIPANT:

Unit Price

Number of persons

Summary

Tour 1

Tour 2

Tour 3

Tour 4

Tour 5

Total payment:

OVERALL COST :

PARTICIPANT:

Unit Price

Number of persons

Summary

Conference fee

Hotel

Transport from the airport

Transport from Molo to Magellan

Programme for Accompanying Person

Total payment:

Registration will be completed after the organizers receive a copy of a document of money transfer.

Please take one copy of the document proving money transfer to the Conference .

 

Transfer money to:

PRZEMYSŁOWO-HANDLOWY PBK S.A. ODDZIAŁ W ŁODZI AL.KOSCIUSZKI 63 90-950 LODZ
IBAN PL 93 1060 0076 0000 4099 6003 4687 SWIFT CODE: BPHK PL PK