application form - Dielectrics Research Group
Workshop
Polymer Nanocomposites: Synthesis, Properties, Modeling, Applications
National Technical University of Athens, Zografou Campus, Athens
16-17 J UNE 2015 http://dielectricsgroup.physics.ntua.gr/ARISTEIA
APPLICATION FORM
The participation in the workshop is free of charge. The number of participants will be limited, therefore the filled form should be submitted by 10.06.2015
, via e-mail to: kroula@gmail.com
Last Name .............................................. First Name ...................................................
Title ( Dr / Mr / Mrs ) ………………………………………………………..
Organization / Dept. .............................................................................................................
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Postal Code ............................... City …………… Country ...........................................
Telephone ………………… Fax ……………………..
Email: …………………………….
1. Current interests in relation to the topics of the workshop:
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…………………………………………………………………………………………………………
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2. With respect to poster session (please tick appropriate box).
□ I intend to present a poster
□ I do not intend to present a poster
3.
Certificate of participation requested (please tick appropriate box).
□ yes □ no
