International University of Andalusia

APPLICATION FORM (*) WORKSHOPS “CURRENT TRENDS IN BIOMEDICINE”

WORKSHOP TITLE

SURNAMES NAME SEX Male Female

DATE OF BIRTH IDENTITY CARD OR PASSPORT Nº NATIONALITY

HOME ADDRESS (including ZIP code, town/city, province/state and country)

COMPLETE WORK ADDRESS (Department, University or Research Centre, etc)

ZIP CODE TOWN/CITY PROVINCE/STATE COUNTRY

TELEPHONE FAX (include area code) (include area code)

E-MAIL ADDRESS

ACADEMIC QUALIFICATIONS

PROFESSIONAL OR SCIENTIFIC TITLE (Group Leader, Post-doc, Ph.D., PhD student, etc.)

(*) The application must include:

- A summary of the current research work of the candidate - A summary for the Poster (no more than one page, including title, authors, research centre, address and summary of the presentation)

Please send the completed application form and attached documents as separate Word files, in a single e-mail message to: [email protected]

In compliance with the Organic Law 15/1999 of 13 December on the Protection of Personal Data, the International University of Andalusia (UNIA) informs you that the personal data collected will be incorporated in a file whose controller is the UNIA, established in Monasterio Santa María de las Cuevas, c/ Américo Vespucio nº 2, 41092 - Sevilla, with the purpose of managing your application. The data is able to be disclosed to other Public Administrations as foreseen by law and to BNV. You can exercise your rights of access, rectification, erasure and objection by writing to LOPD Area at the direction mentioned above, joining a photocopy of your identity card or passport, or mailing to [email protected], or attending to the services of attention to the public in any headquarters of the UNIA. By firming this form you give your consent to the transfer of the identity data, within the educational activity, to the lecturers established in countries outside the European Union.

Rector of the International University of Andalusia (UNIA)