GEOMETRIC ANALYSIS AND INDEX THEORY

ITCP , Trieste, 18 - 24 March , 2001
REGISTRATION FORM

 

PERSONAL DATA

SURNAME (family)

FIRST NAME

CITIZENSHIP
MALE / FEMALE
HOME PHONE NUMBER
PROFESSIONAL INFORMATION

POSITION

INSTITUTION

DEPARTMENT

STREET

CITY

COUNTRY

OFFICE PHONE NUMBER
E-MAIL
FAX

WWW ADDRESS

DO YOU BELONG TO THE "GEOMETRIC ANALYSIS" NETWORK ?


YES     NO

FOR STUDENTS ONLY
HIGHEST UNIVERSITY DEGREE OBTAINED
YEAR
INSTITUTION

DATE OF BIRTH
Month  Day   Year
ARE YOU A YOUNG RESEARCHER IN THE NETWORK ?

YES      NO

ACCOMMODATION
DATE OF ARRIVAL
DATE OF DEPARTURE
I WOULD PREFER A SINGLE ROOM IF AVAILABLE

YES      NO
I WOULD LIKE TO SHARE THE ROOM WITH
SPECIAL NEEDS (food, accommodation,
arrival or departure days,...)


EL (iml), le 19/09/2000