XVI Training Course in the Physics of Strongly Correlated Systems

Vietri sul Mare (Salerno), Italy

October 3 - 14, 2011

Application form

Title: Prof., Dr., Mr., Ms., Mrs., Miss
First Name:
Middle Name:
Family Name:
Age:
Nationality:
Sex: Male, Female
Position: Faculty, PostDoc, Graduate Student
Affiliation:

Country:
Complete Mail Address:

Tel:
Fax:
E-mail:
Present research interests, Brief curriculum vitae since graduation, five most recent publications and motives for wishing to attend the Training Course [(Optional) Comments on benefit of participation from Supervisor]:

Arrival Date (dd/mm/yyyy):
Departure Date (dd/mm/yyyy):

Some of the participants will have the opportunity to deliver a 30 minute seminar during the training sessions.
Title of seminar:
Abstract of seminar:

Request for grant covering staying expenses
Will your institution/research grant/other sources be able to fund your staying expenses? Yes, No, Partially
If partial support is available, please specify its amount in $ or € (Euro):