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1. Name (family name, first name):
2. Affiliation:
3. Address:
4. Position (Permanent / Postdoc / Research Student):
5. Nationality:
6. Country of residence:
7. Do you wish to be considered for funding?
7a. If so, give your Date of Birth:
8. Research Interest:
9. Further info?
Postdocs/Research students:
10. Name and e-mail of advisor or grant holder (if relevant):