Scheda di iscrizione - Fiche d’inscription

Application form - Anmeldung

Ho intenzione di partecipare al colloquio. Vi prego di inviare ogni ulteriore informazione al seguente indirizzo:

J’ai l’intention de participer au colloque. Je vous prie de m’envoyer tout renseignement complémentaire à l’adresse suivante:

I wish to attend the colloquium. Please send all information to the following address:

cognome _____________________________________________________

(Nom de famille/ Surname/ Familienname)

nome  ________________________________________________________

(Prénom/ Forename/ Vorname)

indirizzo _____________________________________________________

(Adresse/ Address/Adresse)

Città_________________________________________________________

(Ville/ Town/ Stadt)

Paese ________________________ Codice postale __________________

(Etat/ Country/ Staat)                                 (Indicatif postal/Post code/Post-kode)

Telefono _______________ Fax ______________ E-mail _____________

(Téléphone/Telephone/Telephon)

cognome __________________________ nome  ____________________

(Nom de famille/ Surname/ Familienname)           (Prénom/ Forename/ Vorname)

dell’ (degli) accompagnatore (i)/ de la (les) personne (s) d’accompagnement/ of accompanying person (s)/ einer/von Begleitpersonen

Desidero inoltre presentare una comunicazione sul seguente argomento:

De plus, je souhaite présenter un exposé qui portera sur l’argument suivant:

In addition, I should like to give a lecture on the following subject:

_______________________________________________________________

_______________________________________________________________

In/en/in ____________________________

Lingua/Langue/Language/Sprache

____________________                                     ________________________________

Data/ Date/ Date/ Datum                             Firma/ Signature/ Signature/ Unterschrift

home