Euromediterranea Euromediterranea euromediterranea 2004 Summer School

euromediterranea 2004

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Partecipation Form For The International Summer School

I request to partecipate in the international summerschool that will take place in Bolzano. Board expenses are payed by the Foundation, payable true the bank or cash on the beginning of the summerschool.

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)