CHANGINS-APPLICATION FORM
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Registration form: Personal Information
  
Personal Information
 
    Remark / Example
  Mrs Mr Ms * = mandatory fields
First name * John
Last name * Doe
Function
Principal affiliation *
Department/Institute
Address Bugnon Street 21
City Lausanne
State US only
Zip 1005
Country Switzerland
Telephone * +41 21 692 50 34
Fax  
E-mail * john.doe@unil.ch
Do you want to submit an abstract?
     
Account information
Username *

Your personal account will be created, allowing you to:
1) Edit your abstract (before the reviewing process)
2) Submit another abstract
3) Make a quicker registration

Choose password *
Confirm password *