PARTICIPATION APPLICATION FORM 37th INTERNATIONAL NATHIAGALI SUMMER COLLEGE ON PHYSICS AND CONTEMPORARY NEEDS, 25th June 7th

h July, 2012, Nathiagali, Pakistan

Indicate the scientific activity of interest: Activity-I (25th June 30th June, 2012)
Astrophysics/ Particle Physics/ Cosmology/ Space Physics

Activity-II (2nd July 7th July, 2012)

Accelerator Physics and Applications

Name: (Underline Surname) .. Father's/Spouse Name: .....Marital Status .......... Date of Birth .................. Place of Birth ............ Nationality .... Official Address: Phone: Fax: E-mail: ................ Home Address:

Preferred Mailing Address (Please tick):

Office

Home

FOR OVERSEAS APPLICANTS ONLY Passport No: Expiry Date: . Education (Masters Degree and above): Institution attended Period (Years) to to to Degree obtained/Subject . .... .... Date/Place of Issue: ... Nearest Departure Airport:

Title of thesis: M.Sc. /M.S.: Ph.D.: Previous and current scientific and academic responsibilities: Institution Period (Years) to to

Responsibilities/Position:

. ....

Work done during the last five years and current field of interest: (Please give a 50-words summary and enclose list of publications)

Title of paper / poster to be presented (if any):

Travel expenses required

Half

Full

No

Previous Nathiagali Summer Colleges attended: (Topic & Year)

Any medical problems:

Undertaking If selected, I will participate in the Summer College for the entire duration offered to me

Signature:

Please Don't Forget To Enclose: 1. Two recent photographs 2. List of publications during the last five years.

Deadline for receipt of requests: 07th April, 2012 Mailing Address: Executive Secretary International Nathiagali Summer College, PAEC, P.O. Box 1114, Islamabad, Pakistan Fax (+92-51) 9208533/9204908 Email: insc@comsats.net.pk