Walter Marget Workshop application:
Deadline for applications: March 31, 2011
*Surname:
*First name:
*Title
Mr.
Ms.
Dr.
Prof.
*Male/Female:
Male
Female
*Are you an ESPID member:
Member
Non-Member
*Current job/position:
Full Work address
*Street
*Town
*Zip
*Country
Full address for correspondence (if different):
Street
Town
Zip
Country
*Contact telephone number(s):
*Contact fax number:
*Contact email address:
Date of application:
Reason why you would like to attend the workshop:
* = Required field
