Application Form

ETIC Session
Maastricht, October 11th-22th, 2004

APPLICATION FORM

SURNAME
First Name
Date of birth

Nationality

PRIVATE ADDRESS
Street
City and postal code
Country
Tel :

WORK ADDRESS
University (or Research Centre)
Street
City and postal code
Country
Tel :
Fax :
E-mail :

PhD PROJECT (Title)

Name of the supervisor :
Starting date :

To be filled and sent back to flasaquier@cournot.u-strasbg.fr before August 31st , 2004

ATTACHMENTS
1) Detailed CV
2) Abstract of the PhD project (max 5 pages)
3) Letter of recommendation of PhD supervisor

Mail address : Patrick LLERENA - BETA - 61 avenue de la Forêt Noire - F-67000 Strasbourg (FRANCE)
To get an idea of the programme, check on the following web site the programmes of previous years :
http://cournot2.u-strasbg.fr/users/etic/

SURNAME First Name	Date of birth
	Nationality
PRIVATE ADDRESS Street City and postal code Country Tel :	WORK ADDRESS University (or Research Centre) Street City and postal code Country Tel : Fax : E-mail :
PhD PROJECT (Title)	Name of the supervisor : Starting date :
To be filled and sent back to flasaquier@cournot.u-strasbg.fr	before August 31st , 2004