REGISTRATION FORM

FSC Summer School 2015

Food Security and the Post 2015-Agenda
University of Hohenheim
March 2 March 13, 2015

Please fill in electronically or print clearly in block capitals.

Personal data
Family name:
First name(s):
Sex

Female:

Date of birth:

Year:

Male:
Month:

Day:

Current address
Address line 1:
Address line 2:
Postal code:
City:
Country:
Phone:
Fax:
Email:
Academic profile
Degree currently pursued:
Major fields of study:
Date of enrolment:

Year:

Month:

University:
Language proficiency in English:

Poor:

Moderate:

Good:

Accommodation (choose one of the options below)

I wish to book a room for the duration of the summer school for ca. 300-400:
I will take care of arranging accommodation myself:

Contact in case of emergency

Family name:
First name(s):
Relationship:
Address line 1:
Address line 2:
Postal code:
City:
Country:
Phone (private):
Phone (work):
Cell phone:
Fax:
Email:
Motivation for participation in the summer school, academic background and relevant
prior studies:

Applicant signature
I wish to attend the FSC Summer School 2015 "Food Security and the Post 2015-Agenda" at the
University of Hohenheim and hereby confirm that the above information is true and correct.
City, date:

Signature: