ICT with Industry 2020: Registration participants workshop

ICT with Industry 2020

Registration

Accomodation and dinner

Confirm

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Please enter your personal information below.

Given name *

Initials *

Prefix (particle)

Family name *

Date of birth *

Email *

Gender *

male

female

other

prefer not to share

Expertise *

Career stage *

Sector *

Telephone *

Website

Affiliation *

Affiliation Address *

Affiliation Zip Code

Affiliation Country *

Affiliation state *

Affiliation city *

Abbreviation *

In case of emergency (name) *

In case of emergency (number) *

Yes, I want to be included in any public list of participants.

Yes, you may use my personal information for this event.

Yes, you can keep my details for future events.

Items marked with an asterisk (*) are mandatory.

If you are experiencing issues when trying to register please send a mail to draft@lorentzcenter.nl