REGISTRATION FORM for

THE INTERNATIONAL SCIENTIFIC CONFERENCE

Ergonomics – opportunity

for new human jobs organized within the ERGO WORK Project funded by European Union

Siedlce University of Natural Sciences and Humanities (Main Library)

9, ks. Jerzego Popiełuszki Street

08-110 SIEDLCE (Poland)

16th September 2015

Name and Surname: ……………………………………………………………………………….

Academic Title/Degree: ……………………………………………………………………………….

Participation with a paper

without a paper

The Title of Presentation:

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Language of the Paper English Polish

Place of Employment: ……………………………………………………………………………….

Position: ……………………………………………………………………………….

Mailing Address: ……………………………………………………………………………….

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e-mail: ……………………………………………………………………………….

phone, fax: ……………………………………………………………………………….

Faculty of Economic and Legal Sciences

17/19, Żytnia Street, 08-110 Siedlce (Poland)

Secretariat of the Conference:Marzena Wójcik-Augustyniak