Application Form
		(Submission Deadline: 15 May 2002)

	2nd INTERNATIONAL SCHOOL ON FORMAL METHODS FOR THE DESIGN OF 
	COMPUTER, COMMUNICATION AND SOFTWARE SYSTEMS:
	MODEL CHECKING (SFM-02:MC)
	
             Bertinoro, Italy, 9-14 September 2002


FIRST NAME:
FAMILY NAME:
MALE/FEMALE:
DATE OF BIRTH:
PLACE OF BIRTH:
NATIONALITY:

TITLE:
POSITION:
AFFILIATION:
ADDRESS:
ZIP CODE:
CITY:
STATE:
COUNTRY:

PHONE:
FAX:
E-MAIL:


FEES
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Registration:           	 400 EUR
Accommodation (half board):      400 EUR
                                 -------
                               	 800 EUR

GRANTS
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1. I request no grant.
2. I request a grant for:
            - my registration  (up to EUR 400): _________
            - my accommodation (up to EUR 400): _________