COST is supported by the EU Framework Programme Horizon 2020

2nd MemoCIS Training School, 7-9 May, 2016, Alghero, Italy

APPLICATION FORM

Name:

Gender: Male Female

Nationality: Date and place of birth:

Institution name:

Institution address:

Employment status (student/professor/post doctoral fellow/engineer):

E-mail:

I would like to apply for financial support: Yes No

I would like to present a poster: Yes No (students are required to present a poster)

Tentative title:

ACCOMMODATION

Which nights will you require accommodation?: 7 10

FINANCIAL SUPPORT

If you are applying for financial support:

1. Status:

Ph.D. student

Obtained Ph.D. after October 2001

Non of the above

2. Research Area:

3. Name and affiliation of academic supervisor:

Please send this application form and your curriculum vitae/resume (max. 3 page) to:

memocis@ucy.ac.cy

May

8 (Choose a max of 4 nights if you will attend all 3 days)

6

Surname:

9