JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Registration Form
WTMC Summer School on 22-26 August 2016
Place: Soeterbeeck
Elleboogstraat 2, 5371 LL Ravenstein
Phone: +31-(0)24-36 15999, +31-(0)6 51 38 74 33
Fax: +31-(0)486 41 74 59
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Surname
*
Your answer
Date of birth
*
dd| mm| yyyy
Your answer
Gender
*
Female
Male
University/Organisation
*
Your answer
Department
*
Your answer
Postal address of university /organisation (not your private address)
*
If you want to receive your reader to different address (home?), please the add the address to remark below.
Your answer
Postal Code
*
Your answer
City
*
Your answer
Country
Your answer
E-mail address
*
Please check your email address for any spelling errors.
Your answer
Are you a registred participant in the WTMC PhD training program?
*
Yes
No
Other:
If you are NOT a registred participant in the WTMC PhD training program, please indicate the following: 1. department and university where you are registered to do a PhD; 2. name of your PhD supervisor?
Your answer
If you are an external participant are you an EASST member?
Yes
No
Clear selection
What is the topic of your research (5 lines)?
*
Your answer
Do you want to give a presentation of your work? If so, then you will be asked for a title and for an abstract.
*
Yes
No
During this workshop all meals are vegetarian.
*
Do you have special dietary needs? Please specify them in the box below.
No special needs
Other:
Required
Hotel room reservation
*
Check in on 22 August 2016
Check out on 26 August 2016
Other:
Required
Invoice address
*
Address + budget or project or SAP number required by your organisation + contact person
Your answer
Remark or question
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
