COULOMB '11

Optical Acceleration of Ions and Perspective for Biomedicine

November 4 - 5,  2011
Sala Refettorio, Istituto Storico Parri, via S. Isaia 18, 40123 Bologna (ITALY)

Registration Form

Personal Data

First Name:
Family Name:
Gender: M    F
Nationality:

Academy Position and Institution

Academic Position:
Institute:
Department:
Address:
Country:
Tel.:
Fax.:
E-mail:

Arrival/departure dates

Arrival date : November 2011.     Departure date: November 2011.


Talk/Poster

Are you interested in presenting a short communication/poster?
(Invited speakers: please tick the button "Talk".)

Talk    Poster    None
If yes, you must give a title.

Title:


Please give a short abstract of your talk/poster (formulae must be entered in latex):



Please feel free to add here any comments you may think useful, like particular accomodation or food needs, or details of your travel (Airplane no. - etc...):

An email confirming your registration will be sent to you soon. If you do not receive within a day, please contact us.