APPLICATION FORM
Summer School on Magnetic Resonance in Food Science

Part I - Personal information

Family name _________________________________________________ Gender ____________
First name ______________________________________________________________________
Address__________________________________________________________________________
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Tel. no: ___________________________________ Fax no: ______________________________
E-mail:__________________________________________________________________________
Native language ___________________________________________________________________
Citizenship:_____________________________________________________________________
University/Employment:____________________________________________________________
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Please rate your level of English
 Basic
 Intermediate
 Advanced

Part II – Education and professional experience

Current University/Enterprise Affiliation
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Current position
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Current professional experience
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Previous professional experience
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Other relevant experiences
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Information about current research you are doing
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Motivation to attend to the summer school

	

PLEASE READ CAREFULLY

I, the undersigned, hereby declare that all information provided in this application form are truthful and accurate and that no relevant information has been left out.
By signing this form the applicant allowes Porto Conte Ricerche Srl to use all data provided in this form for summer school purposes. These data will always be used respecting the privacy of individual persons.

OTHER DOCUMENTS REQUIRED
Please send this application form to the email address summerschool@portocontericerche.it by the established deadline together with your personal curriculum vitae.

Signature ...........................……………………..      Date .........................................