XI Summer Diffiety School - Online Registration Form (Res&Prof)

I am a Researcher/Professor and I would like to participate to the XI Summer Diffiety School

First name: (!)

Middle name:

Family name: (!)

Achademic Title(s):

Gender: (!)

Place of birth: (!)

Date of birth:

Address, street: (!)

Address, city: (!)

Address, ZIP code: (!)

Address, country: (!)

Telephone number (with international prefix): (!)

E-mail: (!)

I need invitation for visa purposes: (!)

Passport series and number:

Passport issuing and expiration dates:

My name exactly as is spelled on the passport:

Address for invitation (if different from the address given above):

Research Area: (!)

Affiliation: (!)

Special requests:

I'm interested in "B" courses, for beginners:

I'm interested in "A" courses, for advanced students:

I'm interested in "C" courses, for veteran participants:

The subject which interests me more is:

I would like to give a talk during the School:

(Preliminary) title of the talk:

ISTITUTO ITALIANO PER GLI STUDI FILOSOFICI

Diffiety School

Supported by the Department of Mathematics and Informatics of Salerno University