Registration Form (fill in and send by e-mail!)

Surname :
First Name :
Gender : 			Male       Female
Date of birth : 			DAY 		MONTH	YEAR
Place of birth : City		Country
Nationality/ies   		(CEE and/or other)
Passport : 			Country : 		Passport Number :

Personal address and contact (mail, phone, fax) :

Professional address and contact (mail, phone, fax) :
(Laboratory, University, Company, etc.)

If you are planning to move soon to another laboratory/University, please indicate it here:

Your status (Student, PhD, Post-doc, experienced researcher, Engineer, etc.
Date and nature of you last diploma (Master, PhD, etc…)
Name of thesis advisor, group leader, scientific or technical responsible:
Names and mail addresses of researchers/engineers who can provide letters of support (3 max.) : 

Fields of work in research and/or engineering :
Other fields of interest for future work : 

Attach the following files :
Copy of passport (scanned document - pdf, jpeg, gif, etc..)
Copy of Diploma (scanned document - pdf, jpeg, gif, etc.)
Your Curriculum Vitae (max 2 pages)
A letter of motivation explaining why the Cryocourse training is needed for your career. (max. one page).