International  School of Liquid Crystals 
		  
                          18th Course

        Liquid crystal nanostructures and self-assembling:
            from organic electronics to metamaterials
			
         2nd School of the Italian Liquid Crystal Society
		       

                 Erice (Italy), 3 - 10 July, 2011

                      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.

Download a TXT Application FORM - Download a WORD Application FORM