Lorentz Center - Physics with Industry 2019 - the 10th edition! from 18 Nov 2019 through 22 Nov 2019
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    Physics with Industry 2019 - the 10th edition!
    from 18 Nov 2019 through 22 Nov 2019

 
Participants are expected to be present at the Lorentz Center throughout the workshop.
Family Name (Last Name): 
First Name:
Gender: 
Date of Birth:  Type yyyy-mm-dd or Press-> (required for internet access)
Institute (affiliation): 
Address: 
Zip Code: 
City: 
Country: 
Telephone:
Email: 
Personal Homepage:  (to be linked to your name in the participants list)

Almost all Lorentz Center workshops welcome participation of not-invited researchers with an interest in the theme of the workshop, space permitting, while members from the Dutch scientific community are in principle always welcome at the workshops. Please provide below any information concerning your research or background that may be helpful to the organizers in deciding concerning your admission (research field, papers on the subject, collaborations, etc.)

Please state your reasons for wanting to attend the workshop and give a list of recent publications in related areas.
Reasons for attending:  
Publications:  
Current Professional Status:  
You are required to attend the entire workshop week and the company visit.

If you require an accommodation, this will be covered by the workshop. You will be staying in the nearby Hotel Van der Valk. You will share the room with another participant. Single rooms are available upon payment of the extra costs and will be charged to your own account.
Arrival date: Type yyyy-mm-dd or Press->
Departure date: Type yyyy-mm-dd or Press->
Hotel needed
My special requirements regarding hotel accommodation,
meat/food are (eg wheel chair access, presence of elevator)
Please indicate which business challenge you would like to sign up for in order of preference:
First Choice
Second Choice
Please confirm that you have approval of your supervisor to apply. [After selection we will require a written confirmation of your participation. This needs to be signed by your supervisor] 
We are trying our best to assign all participants to their preferred company case. However, this may not be possible for everyone. If that's the case, do not worry and think about what serendipity might bring you. Either way, you'll have a great week.

What’s your field of expertise or topic of interest? 
How many years have you been in your current position? 
What is the name of your supervisor? 
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I do not want my name and email address to be kept and used by the Lorentz Center for future mailings for and/or by the Lorentz Center.
I do not want my name to appear on the list of participants on the workshop website.

You can now  this form or  it.

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