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                  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................................
 
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Present position and place of work....................................... 

Address.................................................................. 

Zip....................... City.......................................... 

Country.................................................................. 

Tel.................................. Fax................................ 

E-mail................................................................... 

Current research interests...............................................
 
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I am willing to present a contribution (poster only)       yes [ ] no [ ] 

Tentative Title: ........................................................

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To be sent, preferably via e-mail, 
to pasini@bo.infn.it or orlandi@fci.unibo.it.