Application Form for Participants

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? *
YesNo
Where would you apply for visa?
(Indicate the Email and full address of the Italian Consular Office where you will apply)

Do you want to request a reduced contribution (€300)? *
YesNo
Explain why you qualify

Do you want accommodation in a single room (€900)? *
If single rooms are not available, we will offer you standard accommodation (€500).
You cannot apply for a reduced contribution (€300) AND single-room (€900).
YesNo

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

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

Remaining characters  100

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.). This information will NOT be available on the Isodarco web pages. (Less than 400 characters, name and spaces included)

Remaining characters  400

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?

Announcement received by email
Printed poster that I have received by mail
From posters displayed. Where?

From a printed advertisement. Where?

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

From the Isodarco website
From another website
From a search engine
I have already participated in other courses Isodarco
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).