Transcript Application form

INTERNATIONAL SCHOOL OF PHYSICS “ENRICO FERMI”
APPLICATION FORM
Course 198: “QUANTUM
SIMULATORS”
22 - 27 July 2016
VILLA MONASTERO – VARENNA, LAKE COMO
To be sent to:
Giulia Loguercio
Sapienza Università di Roma
Dipartimento di Fisica
Edificio Marconi
Piazzale Aldo Moro 5
00185 Roma, Italy
Tel: +39 06 49914262
Fax: +39 06 4454913
[email protected]
Closing date for application: 30 April 2016
Name and surname
Place and date of birth
Nationality
Male
Female
Degree
Date and place of acquisition
Present activity
Affiliation with complete postal address
Tel.
Mobile
e-mail
Recommended by
(enclose a letter of reference from your research group leader or professor testfying to your qualifications and interest in
participating in the Course; enclose also list of publications)
I request student status
I request observer status
I am SIF Member
I am EPS Member
Date
Signature