Last name:
First name:
Citizenship:
Date of birth:
Male/female:
Institute: 
Professional address:

Professional phone:  
Professional fax: 
E-mail: 		

_________If you are a student or a postdoc __________________

Have you previously applied to a Cargese School?	
What year?	
Were you admitted?	
Did you attend?	
List other summer schools attended during the past three years:


STUDIES
Date of the start of University studies: 	
Date of the Master Thesis:	
Title/topic of the Master Thesis :
Advisor of the Master Thesis :		
Date of the start of the PhD :	
Date of the PhD defence :	
Title of the PhD thesis :	
Advisor	of the PhD thesis:
	
Postdoctoral studies :	(year/institute)
	
Past scientific work: 	
	

Current interest and future plans: 	
	
	
What benefit do you expect from attending the School? (studies, teaching, research...)

If you are a student, who are you recommended by (two names)

	
____________If you are a permanent scientist ____________________


Status:

Topic of present research:

Have you previously attended a Cargese School?	If yes, what year?
	
What benefit do you expect from attending the School? 


______________________Accomodation__________________________

Inscription fees (including registration+housing and lunches) 
depend on accomodation. What kind of housing do you request? 
(order by preference from 1 to 3)

( ) 390 euros (camping at the Institute; some camping material can be provided)
( ) 650 euros (shared double room in the village)
( ) 790 euros (single room in the village)
( ) 700 euros (shared hotel double room)
( ) 1100 euros (single hotel room)

If sharing a double room, is there a particular person you would prefer
sharing it with?

_________________________Local expenses_____________________

Local expenses will roughly amount to 
  390-1100 euros for accomodation+lunches+registration fee
+ 250 euros for dinners and breakfasts in restaurants (or less in appartments)

How do you expect to cover your local expenses and your travel expenses?


_____________________________________________________________

If you have any other comments, please write them here: