Application Form for the SegraVis Advanced School on Visual Modelling Techniques
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Friday Afternoon 08/09/2006 - Monday 11/09/2006 in Leicester, United Kingdom
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Dear SegraVis School Participant,

please fill out the following form to let us know your contact details
and scientific status which will help us in organizing the school.

Best regards,
SegraVis School Organization Team

Personal Data:
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Forename(s):

Surname:

Affiliation:

Contact Address:

EMail:

Date of birth:

Nationality:


Education:
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Scientific status (e.g. doctoral student):

Scientific Degrees:

Recent Publications:

Please name two referees with full name, address and email:


School Participation:
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The school will start with tutorials on Friday afternoon and will end on Monday afternoon.

Please give us details if you plan other arrival/departure dates:

Do you have any special dietary restrictions (e.g. vegetarian):

En-suite Accommodations will be provided at Beaumont Hall.
Please let us know if you have any other accommodation in Leicester:

Would you like to give a short presentation during the school
about your current research or tool development? (yes/no)
If yes, please give details:

Do you need a marked certificate for the school? (yes/no)
If yes, please give details: