Must be sent before 4th of April 2018 Paper title (in English) (required): Name of the institution - in English (required): Name of the institution in national language (optional): Address (street, number) (required): City (required): Country (required): ERASMUS+ code (optional): Office phone number/ FAX (optional): I would like to ask for FREE PARTICIPATION (fee* zero Euro): YesNo /the university offers support to a limited number of participants/ Official Letter of Invitation is necessary YesNo If “Yes”: - “It should be sent at the same address as above YesNo If there is a different address, please give us the details where the “Letter/ Letters of Invitation” should be sent): Institution/ Office/ Person (required): Address (street, number) (required): City (required): Country (required): Address e-mail (required) FAX (optional): Payment details 50 EURO (fifty EURO) should be paid to the bank account: Institution: Panstwowa Wyzsza Szkola Zawodowa w Tarnowie, Address of the institution: Mickiewicza 8, 33-100 Tarnów, Poland Bank name: Bank Pekao S.A. Bank account: PL68 1240 4748 1978 0000 4878 0285 SWIFT (IBAN): PKOPPLPW The fee is 50 EURO per each person and it includes: Conference materials (open access) accommodation (hostel or dormitory, up to 3 nights). Breakfast and lunch on 16th of May, breakfast and lunch on 17th of May Professional visit Personal data for each person (teacher/ student): Name (required): Surname (required): Academic title (optional): Title Mr.Mrs. Contact e-mail (required): Phone number/mobile phone with the country prefix (required): Passport number or ID card number (required): Office phone number/ FAX (optional): Address (street, number) (optional) : City (required): Country (required): I would like to ask for accommodation (hostel /or dormitory): YesNo If “Yes” please, tick the appropriate date when accommodation is needed: 15/16 of May 2018 16/17 of May 2018 17/18 of May 2018 Optional: I would stay by myself at the address (give us address of the hotel/ hostel): Please remind about the European Health Insurance or Equivalent! Optional: My insurance is: All your personal data will be transferred pursuant to Regulation (EC) No. 45/2001 of the European Parliament and the Council on the protection of individuals with regard to the processing of personal data by the Community institutions and bodies and on the free movement of such data. The data will be transferred only in relation to the execution of the students/ teachers mobility and supplementary actions by the University, or the European Commission, with the possibility of transferring the data to the authorities responsible for inspection and audit in accordance with Community legislation (the Court of Auditors or the European Anti-Fraud Office (OLAF)). Upon written application, the person may gain access to his/her personal data and correct any information which is incorrect or incomplete. The person should refer all the queries concerning the processing of his/her personal data to the University. The person may file a complaint with reference to the processing of his/her personal data by the University to the Inspector General for Personal Data Protection or the European Inspector for Personal Data Protection in relation to the use of these data by the European Commission.