Information Form for
IPL International Summer School
in Science and Engineering 2017

Please submit this form by May 15th
Form to be completed once you have reserved your travel plans and have a proof of insurance
A firm confirmation of your participation is given once the full fee has been paid

PERSONAL INFORMATION







SIGNIFICANT INTERNSHIPS OR WORK EXPERIENCE



HOW DID YOU LEARN ABOUT THE PROGRAM?

CONTACT IN CASE OF EMERGENCY




SPECIFIC HEALTH ISSUES

Are you on a special diet?

NoYes

(Important Information for the final dinner in a restaurant organized during your stay)

Do you suffer from any food allergies?

NoYes

Are you allergic to certain medicine?

NoYes

Have you got any specific health problems?

NoYes

(If you follow a specific treatment please bring the generic names of the products you are taking.)

IN WHICH IPL SCHOOL DO YOU WANT TO COMPLETE THE SCIENTIFIC/TECHNICAL PART OF THE PROGRAM

TRAVEL DETAILS - ARRIVAL IN LYON:




Please upoad a copy of your travel insurance and your passport (ID photo page) here.

Please upload your travel insurance here (PDF only)

Please upload your passport (ID photo page) here (PDF only)

COPYRIGHT OF PHOTOGRAPHS

I grant the Engineering Schools of IPL/Institut Polytechnique de Lyon (CPE Lyon, ECAM Lyon, ISARA Lyon, ITECH Lyon) the right to use, reproduce, display for any purpose whatsoever, the photographs/videos taken of myself individually or in a group of persons during the 'IPL International Summer School in Science and Engineering' organised in Lyon, France, in June/July 2017does not grant this right

I grant the engineering schools of IPL the right to use, reproduce or display, for promotional use, any photographs that I will take and that I may wish to share with the staff.does not grant this right