COURSE INSTRUCTOR: Dr. Andrei A. Zlota Company Name* Title*Dr.Mr.Ms.Course Selection*Feb 13-15, QbD (B)Mar 12-14, Design SpaceApr 16-18, CrystallizationMay 21-23, QbD (A)Jun 18-20, Design SpaceAug 20-22, Reaction DevSept 10-12, QbD (B)Oct 8-10, QbD (A)Nov 12-14, CrystallizationName* First Last Job Title* Address* Street Address City Post/Zip Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country e-Mail Address* Office telephone number*Mobile telephone number*Registration CONFIRMATION Upon confirmation of registration an invoice shall be e-mailed to the registrant for payment by electronic bank transfer. CANCELLATION POLICY*Cancellations must be made in writing at info@thezlotacompany.com, and they are subject to a 390 EUR cancellation fee. If cancellation is made more than thirty (30) days prior to the course, a refund equal to the fee paid minus the 390 EUR cancellation fee shall be issued. If cancellations are made less than thirty (30) days prior to the course, a voucher for the value of the fee paid minus 390 EUR cancellation fee will be issued for use towards the fee of another course offered by The Zlota Co., either by the same registrant, or by anyone else in that company. If a registrant fails to attend but has not cancelled the registration, neither a refund nor a voucher shall be issued. Requests for substitutions must be made in writing to: info@thezlotacompany.com. Hotel cancellations are the responsibility of the registrant. I agree with the cancellation policy described above We will store your contact information securely, and use it for the purpose of communicating course updates, sharing it only with participants of the same course for which you registered. Additional details regarding our privacy policy can be found at http://www.thezlotacompany.com.We will store your contact information securely, and use it for the purpose of communicating course updates, sharing it only with participants of the same course for which you registered. Additional details regarding our privacy policy can be found at http://www.thezlotacompany.com. I agree to have my contact information shared with third parties