EMS2017 – letter of invitation request

Personal data

Prof.

Dr.

Salute: *

First name: *

Last name: *

Company / University:

Department / Institution:

Street / PO box: *

ZIP code: *

City: *

Country: *

Phone:

Fax:

Email: *

Passport number:

Date of birth (dd/mm/yyyy): *

/ /

Copernicus Office user ID:

Abstract ID:

	The letter is for visa purposes (hard copy by air mail is necessary).
	The letter is for funding purposes only (electronic PDF file is sufficient).

Fields marked with an asterisk (*) are required.