International  School of Liquid Crystals  
                         13th Workshop
   
           Colloids, Interfaces and Liquid Crystals
   
              Erice (Italy), 19 – 25 July 2006
 
                      APPLICATION    FORM 
Surname.......................................................    
Name..........................................................    
Date and place of birth.......................................    
Present nationality...........................................    
Degree and other academics qualifications.....................
..............................................................    
Present position and place of work............................    
Address.......................................................    
Zip.................. City....................................    
Country.......................................................    
Tel..............................Fax..........................    
E-mail........................................................    
Current research interests....................................
..............................................................    
I am willing to present a contribution (poster only) 
                                                yes [ ] no [ ]
Tentative Title: .............................................
..............................................................

To be sent, preferably via e-mail, to orlandi@ms.fci.unibo.it and
gregor.skacej@fmf.uni-lj.si .

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