Application form


(*) fields with an asterisk must be completed
Main informations
* Surname:* Firstname:
* Title:* Birthdate:
* Function:* Nationality:

* E-mail:Mobile Phone:
Office Phone:Home Phone:
Office Fax:Home Fax:

* Street:* Number:  Box :
* Postcode:* City:
* Country:

Current or professional occupation
Institution:
Position:
Responsabilities:
University
Name:
Faculty - School - Institute:
Degree
Degree:
* Speciality:
Other:
Other
Language for lectures: French
English
* Course fees: 600 euros (Students till Master)
750 euros (NGO's and PhD)
950 euros (Professionals)
* Lodging:
* How did you first hear about the program: