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

Augusto Micheletti, Secretary of CIRM
Fondazione Bruno Kessler

Via Alla Cascata, 56C - Povo
I-38123 Trento, Italy
micheletti@fbk.eu

REGISTRATION FORM

School “Motives Today”

Hotel Villa Madruzzo (Cognola, Trento), June 3^rd – 7^th, 2019

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 2^nd afternoon):

Departure date (standard: Friday, June 7^th after lunch):

Date:

Signature