Registration Form for ESQG14

Thank you for registering to the ESQG 2014 workshop.

Please, insert your complete data. When your registration will be sumbmitted, you will receive an email to the specified address. If you fail to receive it, please contact us at esqg2014@sissa.it.

Name *

Family name *

Sex *

Italian Tax Code No.

Mandatory for people that are working or studying in Italy.

Date of Birth *

Day

Month

Year

Place of Birth *

Region / State

If applicable.

Country *

Citizenship *

Address

Street *

No. *

Town *

Region / State

If applicable.

Country *

Postal Code *

E-mail *

Institution *

Invited *

Yes

Arrival date *

Day

Month

Year

Departure date *

Day

Month

Year

Do you wish to submit a talk and provide a tentative title and an abstract *

Yes

Title *

Abstract *

Comments / Special requirements

In compliance with Italian law. 30/06/2003, No. 196, concerning "processing of personal data", with the rights granted to you by Art. 7 of the same, please note that the information you provide will be included in our database and used only for purposes directly related to the activity of the site. By signing and sending this application you consent to the processing of your personal data for the purposes and conditions set forth herein.

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Registration Form for ESQG14