International  School of Liquid Crystals 
		  
                          15th Workshop

            Liquid Crystal Phases and Nano-Structures		  
     

           Erice (Italy), 27 October - 1 November 2008

                      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 pasini@bo.infn.it or orlandi@fci.unibo.it.

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