Mailing list

Organizers

The application form for Satellite space at the Second Eastern European and Central Asian AIDS Conference (EECAAC2008)

Full name of the organization:	*
Abbreviation of name:		(if applicable)
Country:	*
Field of work:	*
Type of organization:	*
Zip:	*
Contact address:	*
Telephone number :	*	(country code, area code, number)
Additional telephone number:	*	(country code, area code, number)
Fax number:	*	(country code, area code, number)
E-mail:	*
Web-site:
Legal address of the organization:	*
Bank details:	*
Full name of the head of the organization:	*
Position of the head of the organization:	*
Requested terms
Date and time requested:	*
Satellite's theme:	*
Will you order additional equipment?	*
Contact person Simplified registration form for EECAAC2008
Surname:	*
Name:	*
Patronymic (second name):
Position within the organization:	*
Country of residence:	*
Telephone number:	*	(country code, area code, number)
Additional telephone number:	*	(country code, area code, number)
Fax number:	*	(country code, area code, number)
E-mail:	*
Additional e-mail:
The information requested in the section below will not be reflected in your form. It will be used for statistical purposes only.
Sex:	*
Age:	*
Please type the characters you see in the picture on the right:	*