Formularz zgłoszeniowy

Application form for the XXX conference entitled “New aspects on chemistry and application of chitin and its derivatives. Chitin, chitosan and other polysaccharides.”
The conference will be held in Łódź on September 24-26, 2025.

By submitting the application, I consent to the processing of my personal data in order to register for the conference “New aspects on chemistry and application of chitin and its derivatives. Chitin, chitosan and other polysaccharides” and I consent to the free use of my image recorded in the form of a photograph or on a film for informational and promotional purposes related to the implementation and course of the conference “New aspects on chemistry and application of chitin and its derivatives.Chitin, chitosan and other polysaccharides.”“ by posting a photo and / or video report from the conference on the website of the Polish Chitin Society and its profiles in social media.

First name*:	Last name*:
Academic degree*:	Affiliation*:
Contact number*:	Fax:
Street and number:	Postal code:
City*:	Country*:
E-mail*:	Presentation: PosterShort lectureNo presentation
Presentation or poster title:	Author(s):
Dinning options*: MeatVegan
Abstract: (Allowed files .doc .docx .pdf)

Invoice*:

Invoice YesNo (duplicate data from the above form)
Proforma Invoice (before payment) YesNie

Institution / First and last name*:	Street and number:
Postal code:
City*:
Country*:	Tax number: