application form
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EUROPEAN FORUM ALPBACH INEQUALITY 19.08 4.09.2015
APPLICATION FORM
We kindly ask you to fill in this form electronically and send it to the e-mail address:
[email protected]. Deadline for scholarship application: 1 June 2015.
CONTACT INFORMATION
Surname First name Title Nationality (passport)
___________________ _________________________ ______ __________________ University or Company Date of birth
______________________________________________ ________________________________ Field of study or Position Place of birth
______________________________________________ ________________________________
ADDRESS CONTACT PERSON*
Address Surname and first name
________________________________________ ________________________________________
Postcode - City Relation
________________________________________ ________________________________________
Phone Phone
________________________________________ ________________________________________
E-mail E-mail
________________________________________ ________________________________________
* The contacts of this person will be used in case of emergency.
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REGISTRATION Please choose only those events, seminars and working groups which you really intend to attend and that will not take place at the same time.
Seminar Week (19 25.08.) Seminar ___ and ___
Technology Symposium (27 29.08.) Breakout Session ___
Tyrol Day (22 23.08.) Political Symposium (30.08 01.09.) Breakout Session ___ and ___
Health Symposium (23 25.08.) Partner Session ___
Economic Symposium (01 03.09.) Breakout Session ___ and ___
Higher Education Symposium (26 27.08.) Financial Market Symposium (03 04.09.) Breakfast Club ___ and ___
Legal Symposium (26 27.08.) Built Environment Symposium (03 04.09.)
If you do not plan to stay for the entire European Forum Alpbach 2015, please inform us about the duration of your participation.
Participation from to
Remarks ____________________________________________________________________________
PLACE, DATE
____________________________________
SIGNATURE
____________________________________
Surname: First name: Title: Nationality passport: University or Company: Date of birth: Field of study or Position: Place of birth: Address: Surname and first name: Postcode City: Relation: Phone: Phone_2: Email: Email_2: Tyrol Day 22 2308: and: Political Symposium 3008 0109: Economic Symposium 01 0309: and_2: Higher Education Symposium 26 2708: Financial Market Symposium 03 0409: and_3: Built Environment Symposium 03 0409: and_4: Remarks: PLACE DATE: Check Box1: Check Box2: Check Box3: Check Box4: Check Box5: Check Box6: Check Box7: Check Box8: Check Box9: Check Box10: Text6: Text7: