Since 1966 – International School on Disarmament and Research on Conflicts – Italian Pugwash Group

Application Form for Participants

Isodarco reserves the right to cancel the course, postpone it, or introduce changes in the program depending on the development of the world health situation. Should the situation force cancellation, postponement, or major changes in the program of the course, Isodarco will return all contributions received from the participants who will cancel their participation.

    Fields with an asterisk * are required.

    Personal Information for Participants

    Title *
    ProfDrMrMs
    Last (Family) Name *
    First (Given) Name *
    Present Nationality *
    Date of birth. Field required if you need our free Medical Insurance which is necessary for visa application.
    Place of birth
    Gender *
    MF

    Affiliation
    Qualification

    MAIL ADDRESS *
    HomeOffice
    Address *
    Zip Code *
    City *
    State and/or Country *
    Phone (e.g. +39 0663...)
    Mobile (e.g. +39 349...)
    Email *
    The URL of your web page (if available)

    Do you need a visa to come to Italy? *

    Where would you apply for visa?
    (if possible indicate the Email and full address of the Italian Consular Office where you will apply)

    EDUCATION

    HIGH SCHOOL DEGREE
    Degree in *

    Institution *

    Year *

    UNIVERSITY DEGREE
    Degree

    In

    Institution

    Title of the thesis

    Year

    OTHER UNIVERSITY DEGREE
    Degree

    In

    Institution

    Title of the thesis

    Year

    OTHER DEGREES

    Past and Present Professional Activities (Curriculum) and Work Address

    Publication list or Letter of Recommendation

    Fields of Interest

    Indicate if you apply for a reduced fee and why

    Your affiliation as it should appear on the Isodarco web pages *
    (Less than 100 characters name and spaces included)

    A list of all participants will be distributed in printed form at the beginning of the course to help lecturers and participants to know each other, discover common interests that can benefit from a direct encounter and remain in touch after the course. This list should contain all the information about you that you would like to share with all other participants (Name, affiliation, specific interests and responsibilities, email, telephone numbers, work and home addresses, web page, etc.). (Less than 400 characters, name and spaces included)

    If you wish to present a seminar or show a film or organize a spontaneous activity provide the title and a short description of your proposal or fill the form Extra Activity and deliver it to the course secretariat at Andalo.

    How did you hear about the Isodarco Courses?



    From posters displayed. Where?

    From a printed advertisement. Where?

    From a friend, colleague or family member: please indicate her/his name if possible





    Other (please specify)

    Comments

    Notes

    By clicking “Send”, you express your consent to the processing of your data provided in this registration form, under the legal information provided in the “LEGAL INFORMATION PAGE” of the ISODARCO web site (www.isodarco.it), in compliance with the laws and regulations in force (Art. 13 and 14 of EU Regulation 2016/679).

    CV, letters of reference and other documentation can also be sent by email to: isodarco@gmail.com.

    After you have received your admission letter, please confirm your participation and let us know your travel plans and your arrival time as soon as possible.

    An automatically generated message should inform you shortly that your application has been received. If you do not receive it or if you have problems sending this form, please click here to fill out and send it as an email attachment. Thank You.