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

REGISTRATION FORM

School “Topological Data Analysis and Persistent Homology”

Levico Terme (Trento), June 11^th – 15^th, 2018

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: Sunday, June 10^th afternoon):

Departure date (standard: Friday, June 15^th after lunch):

Date:

Signature