Application form

INTERNATIONAL SCHOOL OF PHYSICS “ENRICO FERMI”
APPLICATION FORM
Course 201: “NUCLEAR
PHYSICS WITH STABLE
AND RADIOACTIVE ION BEAMS”
14 - 19 July 2017
VILLA MONASTERO – VARENNA, LAKE COMO
To be sent to:
Sara Pirrone
INFN, Sezione di Catania
Via Santa Sofia 64
95123 CATANIA
Tel.: +39 095 3785394
[email protected]
Closing date for application: 30 April 2017
Name and surname
Place and date of birth
Nationality
Male
Female
Degree
Date and place of acquisition
Present activity
Affiliation with complete postal address
Tel.
Mobile
e-mail
Recommended by
(enclose a letter of reference from your research group leader or professor testfying to your qualifications and interest in
participating in the Course; enclose also list of publications)
I request student status
I request observer status
I am SIF Member
I am EPS Member
Date
Signature