International Research Interdisciplinary School
IRIS Ukraine 2017
May 8 -13, 2017, Zhovkva, Ukraine

Application Form
Your Details		Date and Venue

The 4-day workshop will be held from May 9 to 12, 2016 (arrival May 8, departure May 13) in Zhovkva, about 30 km north from Lviv.	
				
Surname:				
First Name:				
Title / Position:				
Institution/organization:				

Address:				
			Place

Park-hotel  “Aquarel” 
14 А, Vokzalna str.
Zhovkva, 80300, Ukraine
T/F: +38 032 5221021
T: +38  097 3117311
http://hotel-akvarel.com.ua

				
City:				
State:				
Country:				
Zip/postal code:				

Phone:				
Fax:				
E-mail:				
				
Payment			
			
Fee: Euro 200 
(covers accommodation, full board, scientific and social program)
Payment in cash at the place at arrival.		Contact

Mykhaylo Sorokivskyy,
MD, PhD,
Lviv Regional Cardiology Center
Kulparkivska 35, 
79015,  Lviv, Ukraine
T: +38 067 7837830
F: +38 032 2383351
e-mail: sorokivsky@gmail.com	

			
Signature:

Date: