Application Form (Submission Deadline: 21 March 2013) (EXTENDED to: 04 April 2013) SFM-13:DS 13th Int. School on Formal Methods for the Design of Computer, Communication and Software Systems: Dynamical Systems Bertinoro (Italy), 17-22 June 2013 ------------- PERSONAL DATA ------------- FIRST NAME: ___________________________________ FAMILY NAME: ___________________________________ MALE/FEMALE: ___________________________________ DATE OF BIRTH: ___________________________________ PLACE OF BIRTH: ___________________________________ NATIONALITY: ___________________________________ POSITION: ___________________________________ AFFILIATION: ___________________________________ ADDRESS: ___________________________________ ZIP CODE: ___________________________________ CITY: ___________________________________ STATE: ___________________________________ COUNTRY: ___________________________________ EMAIL: ___________________________________ PHONE: ___________________________________ FAX: ___________________________________ ---- FEES ---- Registration fee: 600 euros Please cancel the option you are NOT interested in: 1. Accommodation fee (bed, breakfast and lunch): 350 euros 2. Reduced accommodation fee (only lunch): 100 euros ------ GRANTS ------ Please cancel the option you are NOT interested in: 1. I request no grant. 2. I request a grant for my registration fee (specify amount, up to 600 euros): _________