Please send the form, preferably by e-mail, to

Augusto Micheletti, Secretary of CIRM
Fondazione Bruno Kessler
Via Sommarive, 14 – Povo

I- 38123 Trento, Italy
micheletti@fbk.eu

APPLICATION FORM

Lefschetz Properties and Jordan Type

in Algebra, Geometry and Combinatorics

Levico Terme (Trento), June 25-29, 2018

Family Name:

First Name:

Citizenship:

Full address:

e-mail:

Present professional position:

Reason for attending:

I would like to reserve a double bedroom, to share with …….

Arrival date (standard: Sunday, June 24 afternoon/evening):

Departure date (standard: Friday, June 29 lunch time):

Date:

Signature