4th International School on Foundations of Security Analysis and Design 6-11 September 2004, Bertinoro University Residential Center, Italy FOSAD'04 Application Form First Name: Last Name: Sex (M/F): Date of birth: Place of birth: Nationality: Position: Affiliation: Address: City/State: Zip Code: Country: E-mail Address: Fax: Please select one: [__] I request no grant. [__] I request a grant for my registration (specify amount, up to 350 Euros): ___ Euros. [__] I request a grant for my accommodation (specify amount, up to 350 Euros): ___ Euros.