Please
send the form, preferably by e-mail, to
Augusto Micheletti, Secretary
of CIRM
Fondazione Bruno Kessler
I- 38050 POVO (Trento), Italy
fax: Italy+0461 810629
michelet@science.unitn.it
REGISTRATION FORM
Levico Terme
(
Family Name:
First Name:
Citizenship:
Full address:
e-mail:
Present professional position:
I need financial support: Yes/No
Researchers asking for a grant should indicate
possible advisor and publications (if any):
I would like to share the room with:
Arrival date (standard: October 21 afternoon):
Departure date (standard: October 27 lunch time):
Date:
Signature