Registration Form

Please note that your registration is only official
after our written confirmation of its receipt.

First name
Last name
Gender	Male Female
University/Company
Department
Group
Position
Supervisor (if applicable)
Full postal address
Invoice name
Invoice address
Admission fee	Participants from industry: EUR 500,-- EIDMA members from industry: EUR 400,-- University staff members and PhD students: EUR 300,-- EIDMA university staff members and postdocs: EUR 200,-- Registered Dutch EIDMA PhD students: EUR 0,-- DIAMANT university staff members and PhD students EUR 200,-- I am an undergraduate student, please contact me.
Are you a member of DIAMANT?	yes no
	DIAMANT members can apply for additional DIAMANT support by sending a separate e-mail to j.draisma@tue.nl, indicating the name of the staff member of the DIAMANT group they belong to. I have separately applied with Jan Draisma for additional DIAMANT support: yes no
Telephone number
Telefax number
E-mail address
(TUE students only):
Student identification number
Discipline (math./inf./electr.)
Year of study

Submit