JUAS-registration-formulaire

JUAS 2012

APPLICATION FORM

When registering complete the entire form. Click on the Preview button
Once this form is submitted, please do not resubmit with changes. Fax or email changes to the contact person listed below.

Personal details
	Family Name:
	First Name:
	Sex:M/F
	Year of Birth :
	Nationality (passport) :
	Home University / Institute :
Mailing Address
	Institution :
	Street/P.O.Box :
	City :
	State/Country :
	Postal/Zip code :
	Telephone :
	Fax :
	Email Address :
Educational / professional background
	Are you a full time student / professional /other :
	Highest relevant academic qualification to date :
	Field specialisation :
	Date when expected to achieve this qualification :
	Your status / position (student/PhD/professional etc.) :
Knowledge of English
	oral :
	written :
Accommodation I would like a one bed studio apartment I would like to share a 2 or 3-room apartement I shall be sharing with I would like to share with someone I prefer to stay at the two-star Hotel Ibis I shall make my own arrangements for accommodation
I first heard of JUAS
	through :

Course selected (please click appropriate course)

Course 1: 9 Jan - 10 Feb 2012, five weeks ACCELERATOR PHYSICS

Course 1

which ones

Course 2: 13 Feb - 16 Mar 2012, five weeks ACCELERATOR TECHNOLOGIES AND APPLICATIONS

Course 2

which ones

Comments / request for support (students only) :

Applicants should send by post a CV and a brief letter explaining their motivation and how they feel JUAS will help them in their career
All applications must be supported by an independent reference. An academic/professional supervisor should complete the attached form (reference form) and return it separately to the secretary by post