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Partecipation Form For The International Summer School
Name and surrname _____________________________________________________
Address ________________________________________________________________
City/Cap__________________________________Country_______________________.
tel/fax__________________________________E-mail__________________________
Date of birth _______________________________________.sex__________________
Studies, degrees___________________________________________________________
Activities ______________________________________________________________
Partecipation on behalf of an Association/ Institution (other) _______________________
Known languages _______________________________________________________
Date__________________________ Signature______________________
FONDAZIONE ALEXANDER LANGER STIFTUNG – Onlus
Fondata/Gegründet: 04.07.1999 – Riconosciuta/Anerkannt: 18.11.1999
Via Latemar Strasse 3, I - 39100 BOLZANO/BOZEN
Tel.+Fax. 0039 0471 977691 - E-Mail: langer.foundation@tin.it, www.alexanderlanger.org
Banca/Bank: Cassa di Risparmio di Bolzano - Südtiroler Sparkasse, Conto/Konto Nr. 555000 (Abi 6045 - Cab 11613)