Last name:

First name:

Affiliation:

Address:

Street:
City:	Postal Code:
Country:

Email: (name@host.domain)

Male/Female: (M/F)

Date of Birth*: (Necessary only if you are applying for financial support)

month year

If you are a graduate student or recent PhD please indicate your main research interests and the name of someone willing to send a recommendation letter on your behalf if needed:

Personal Web Page*: (e.g. host.domain/~username)

Fax*:

Do you wish to give a talk (please note that it may be impossible to arrange a slot for
everyone due to the tight schedule)?
No Yes

IF YES, PLEASE SEND US THE TITLE and a SHORT ABSTRACT
(preferably with a list of references):

The participants will be accommodated at the Hotel Tuela, which is located a few minutes' walk from the Department..

Arrival Date: day month

Departure Date: day month

Accompanying person(s):

Type of accomodation: single, double, shared double.
Single Double Shared Double --------
Note: if you chose shared double please indicate below, if you wish, the name of the participant you would like to share the room with

If you require full or partial financial support in order to attend, please explain your situation (students' fees will be covered by the organization). However  we strongly encourage participants to find their own financial support.