Registration Form ( send by e-mail to cryocourse.contact@grenoble.cnrs.fr )

Family name: 
First name:
Gender: 			Male       Female
Date of birth 			DAY 		MONTH	YEAR
Place of birth 			City:			Country:
Nationality/ies   		(CEE and/or other)
Passport or ID?			Country: 		Passport or ID Number:

Personal address and contact (mail, phone, fax):

Professional address and contact (mail, phone, fax):
(Laboratory, University, Company, etc.)

If you are planning to move soon to another laboratory/University, please indicate it here:

Your status (Student, PhD, Post-doc, experienced researcher, Engineer, etc.: 

Date and nature of you last diploma (Master, PhD, etc…)
Name of thesis advisor, group leader, scientific or technical responsible:

Names and mail addresses of researchers/engineers who can provide letters of support 
(3 max.): 

Fields of work in research and/or engineering:
Other fields of interest for future work: 

Attach the following files :

•	Copy of passport (scanned document - pdf, jpeg, gif, etc..)
•	Copy of Diploma (scanned document - pdf, jpeg, gif, etc.) or certificate from your supervisor
•	Your Curriculum Vitae (max 2 pages)
•	A letter of motivation explaining why Cryocourse is needed for your career (max. one page).

Do you need financial support (circle appropriate answers)?

•	living expenses  + registration  (1000€)  	Yes      	No	If  possible
•	travel expenses				Yes      	No	If  possible