History of Mathematics & Teaching of Mathematics
Sárospatak, Hungary
2012. May 23-27.

PERSONAL INFORMATION

First Name:		Last Name:
Phone:		Fax:
E-mail:		URL:
Title:	Prof. Dr. Ms. Mr.	.	.

AFFILIATION

Institution or Company:
Faculty or Department:
Street or P.O.Box:
City:
Country:
Zip Code:

MAILING ADDRESS (if different from above)

Street or P.O.Box:
City:
Country:
Zip Code:

TRAVEL

When Do You Plan to Arrive
When Do You Plan to Leave
Do You Need Official Invitation (e.g. for visa):	Yes No
Do You Apply for Reduced Fee	Yes No

ACCOMMODATION

Nights	23/24	24/25	25/26	26/27
Student Hostels type Facility	Yes * Price: 12 EUR /person/night
Hotel (we only book it for the participants)	Single room Double room
Accompanying person(s):
Please indicate your preference if sharing with a colleague, special requests for accomodation, meals etc.:

OTHER

Do you wish to submit a proposal for a contributed talk?	Yes No
Title of Presentation:
The abstract of the presentation (up to 8-10 lines in normal form): (.tex form is preferred, the same time submit it via the Easy Chair Conference System, and send a copy of the abstract in e-mail to matkp@uni-miskolc.hu)

CHECKSUM

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