Mr.  Ms.    Dr. 

Male      Female 

Name: 

Surname: 

Age:     Country of Citizenship: 

Professional status: 

University: 

Postal Address (University): 

Postal Code:    City:    Country: 

Tel: 

Fax: 

E-mail: 
 
Research experience (full equivalent):

less than 4 years*
more than 4 years and less than 10 years*
more than 10 years*

* counting from the time the degree/diploma was obtained and giving access to embark on a doctorate in the country where it was awarded.

I wish to present a poster     Yes      No 

Title: 

Abstract: 
 
 

VITA INFORMATION

First University (or equivalent) graduation date: 

Discipline : 

University where applicant graduated: 

Brief curriculum vitae since graduation : 

Current or projected research activities and reasons for wishing to attend the WS : 
 
 

Scientific publications of applicant (no more than 5, your best or most recent) Provide title of paper, journal, volume and page numbers, authors.

1. 

2. 

3. 

4.

5.