Conference :
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Gender:
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Last Name :
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First name :
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Date of birth :
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Citizenship :
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Professional status:
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Institution :
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E-mail :
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Phone:
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Postal address :
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Date of first university (or equivalent) graduation:
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Discipline:
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Graduated at:
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Brief curriculum vitae :
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Current or projected research activities and motives for wishing to attend the conference:
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Scientific publications of applicant (no more than 5, your best or most recent)
Give : title of paper, journal, volume and page numbers, authors.
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If the applicant is a doctorant then this form should be commented by the doctorant supervisor
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Comments on benefit of participation from senior scientist (Supervisor, Department Head, etc.)
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Name : |
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Institution : |
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Position : |
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Relation with the applicant : |
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Comments :
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In case of problem with this form, please contact
Jacques Dumarchez
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