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
fax: Italy+0461 810629
michelet@science.unitn.it

APPLICATION FORM

Summer School on Transport, Fluids and Mixing

Levico Terme (Trento), July 19-24, 2015

 

Family Name:

First Name:

Citizenship:

Full address:

e-mail:

Present professional position:

I share the double-bedroom with:

I would like to present a poster: Yes/No

Title of the poster:

Arrival date (standard: Sunday, July 19th afternoon):

Departure date (standard: Friday, July 24th lunch time):
 

Date:

Signature