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

Augusto Micheletti, Secretary of CIRM
Fondazione Bruno Kessler

Via Sommarie, 14 - Povo
I- 38100 Trento, Italy
fax: +39-0461-810629
michelet@science.unitn.it

APPLICATION FORM

6.th School on Analysis and Geometry in Metric Spaces

Levico Terme (Trento), June 7-12, 2009

Family Name:

First Name:

Age:

Sex:

Citizenship:

Full address:

e-mail:

Present professional position:

I need financial support:

I would like to share the room with:

Arrival date (standard: June 7 afternoon):

Departure date (standard: June 12 lunch time):

Date:

Signature