European School on Magnetism 2011 – Request for attendanceAug. 22nd – Sep.2nd 2011, Targoviste (Romania)

Note: / ·  This form consists of a request for participation in ESM2011. Due to the usually large number of requests for participation, a selection process is likely to be implemented. Final acceptance or waiting list status will be notified on June 1st. No payment should be made until that date.

Personal details

Family name: First name:

Gender: Male Female Age:

Lab. or Univ. or Company:

Nationality:

Full address including street name, ZIP, town and country(multi-line editing allowed):

Phone: Fax:

E-Mail:

Student PhD student Post-doc Senior

Research topic (very short):

In case you are a student, PhD or post-doc, please supply the name and Email of your scientist advisor:

Name: Email:

Note: / ·  A support letter from advisor (if applicable) and a personal motivation letter are required.

Links with the Joint European Magnetic Symposia

ESM and JEMS are linked events. We would like to gather information about crossed-participations.

Did-you attend a previous session of JEMS (2010 or other): Yes No

Are you considering attending JEMS2012 (http://www.jems2012.it/): Yes No

Poster contribution

Besides the lectures given by senior lecturers, poster sessions will be organized to allow the attendees to present their research work. Would you like to present a poster:

Yes No

Title:

Note: / ·  No abstract is required.

Accommodation

Meals

Special food requirements:

Room

Accommodation is provided on the basis of double-occupancy room.

If possible I would like to share my room with:

Payment

Registration fees

Reduced: 400€ (student, PhD or post-doc with registration before May 15th and payment before July 1st)

Regular: 600€ (late registration or senior)

Other cases (lecturers etc.)

Note: / ·  The registration fees include accommodation, meals and breaks during the entire school duration.

Send this form back via Email as a Word file (other file formats or Fax of printed forms are accepted in case you face technical problems with the form): . Fax: +33 (0)4 76 88 11 91