Registration form for PhD Modelling Week 2016
Please, fill in this registration form to receive payment instructions.
Registration is confirmed only after payment (final deadline: June 15, 2016).
First Name *
Middle Name
Last Name *
Email *
Email * (type it again)
Dept./Faculty/Institute *
(Please specify, e.g., Department of Mathematics)
University/Company *
City
(if not clear from University)
State/Country *
Referring Professor *
(please indicate the name, the affiliation, the email of a referring professor)
Comments/requests
Payment *
I am employed in a non-Italian EU university/company which will directly pay my registration fee.
I am employed in a public Italian university/company which will directly pay my registration fee. **
I am employed in a private Italian university/company which will directly pay my registration fee.
I will personally pay my registration fee. **
** Se sei affiliato ad un ente pubblico e vuoi pagare personalmente la quota di iscrizione, accertati prima che il tuo Ente poi ti rimborsi. Altrimenti, fai pagare la quota direttamente dal tuo Ente mediante fatturazione elettronica.
* mandatory information
Financial support
I require support for lodging (shared double room in a student house) ***
I require support for travel expenses ***
I require fee reimbursement ***
*** please acclude your CV and a letter by your Referring Professor
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