XIV Training Course in the Physics of Strongly Correlated Systems

Vietri sul Mare (Salerno) Italy

5 - 18 October 2009

Application form 

Title:  Prof. Dr. Mr. 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):