This section must be filled out by all those
registering.
Title
- Prof. Dr. Mr. Mrs. Ms.
First Name(s)
Family Name
Email Address
Full Name of Organisation
Short Name of Organisation (if applicable)
Name of Department / Group / Section
City/Town where your Group / Department is located
Country where your Group / Department is located
- Afghanistan Albania Algeria Andorra Angola Argentina Armenia Australia Austria Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Bermuda Bolivia Bosnia/Herzegovina Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Cayman Islands Central African Rep Chad Chile China Colombia Congo Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dominican Republic East Timor Ecuador Egypt El Salvador Estonia Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gambia Georgia Germany Gibraltar Greece Guadeloupe Guatemala Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea (North) Korea (South) Kuwait Latvia Lebanon Libyan Arab J Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malaysia Maldives Mali Malta Martinique Mauritius Mexico Monaco Mongolia Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Reunion Romania Russian Federation Rwanda Samoa San Marino Saudi Arabia Singapore Slovakia Slovenia South Africa Spain Sri Lanka Sweden Switzerland Syrian Arab Rep. Taiwan Thailand Trinidad/Tobago Tunisia Turkey Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Vatican City Venezuela Viet Nam Yugoslavia Zambia Zimbabwe
This section must be filled out by all those
registering.
Which Workshop are you applying to?
- e-Health e-Environment e-Government WINCO'05
Will you be attending the whole event?
- Whole Event Only Workshop Only Information Day
Have you submited a
project proposal?
- Yes No
This section is optional . For the
event itself we
intend to produce
an informal brochure listing the attendees (contact points) and
organisations represented. The data on size and activity help us judge
appropriateness of event activities.
If you would like your organisation to be represented in the brochure
then please fill out this section.
Short Description of your Organisation (max 300 words)
Organisation's Activity Type
- RES: Research HEC: Higher Education IND: Industrial OTH: Other
Size of your Organisation (number of full-time
employees)
- S1: 0 employees S2: 1-9 employees S3: 10-49 employees S4: 50-249 employees S5: 250-499 employees S6: 500-1999 employees S7: 2000+ employees
URL for your organisation or group (Include
http://...)
URL for your organisation or groups official logo
(leave blank if you prefer it wasn't included)
This section is
compulsory . For the event itself we
intend to produce
an informal brochure listing the project prosals and contact points. If you would like your
proposal to be represented in the brochure
then please fill out this section.
Short Description of your
Project Proposal (max 300 words)
Relevant previous work for this proposal. (max 300 words)
FP7
Challenge
- RES: Research HEC: Higher Education IND: Industrial OTH: Other
Are you going to bring someone with you?
- Yes No
Will you be interested in joining the social program?
- Yes No
Which is your flight plan?
This section is optional . We are still
finalising the Agenda
and any input on particular
interests is welcome. If you would like your interest areas considered
in drawing up the agenda then please fill out this section.
Add your interests
- 1: Yes - Use info below N: No
List of discussion topics you would like to see
covered at the Information Day (max 300 words)