_________________________________________________________________________ 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.