==========================  Application form (e-Mail) ===========================

Name: 

Affiliation / University:

e-Mail:

Gender: 

Accommodation asked for: 
[   ] Atlantic, shared double EUR 67.50 per night and person
[   ] Zur Alten Stadtmauer. shared double EUR 39.50 per night and person
[   ] single room (estimated EUR 52 per night)
Prices (including breakfast) are subject to changes and availability of the special rate rooms.

PhD / postdoctoral research topic:


Supervisor / Advisor:


Further research interests:


Date of arrival: 

Date of departure:

Dietary requirements, disabilities, other needs or comments:





Title of possible poster contribution:

Complete Author list:

Abstract (if possible, please also attach a preprint, poster or talk draft as pdf):




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Please return the completed form via e-Mail to as10 (at) gradschool.uni-luebeck.de 
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