Formulaire URGENSEA - Fondation Andurand

Inscription Form URGENSEA

Please enter the name of your team (provisional)

In which category do you want to compete?

Number of participants in the team (this number may be modified later upon final registration)

First Name(s)

Surname(s)

Please indicate your year of birth

E-mail

Phone number

What is your nationality ?

Please indicate your university

Please indicate your level of studies (bachelor's, master's, doctorate, etc.)

Please indicate the title of your program/course

First Name(s)

Surname(s)

Please indicate your year of birth

E-mail

Phone number

What is your nationality ?

Please indicate your university

Please indicate your level of studies (bachelor's, master's, doctorate, etc.)

Please indicate the title of your program/course

First Name(s)

Surname(s)

Please indicate your year of birth

E-mail

Phone number

What is your nationality ?

Please indicate your university

Please indicate your level of studies (bachelor's, master's, doctorate, etc.)

Please indicate the title of your program/course

Please indicate the names of other participants here, if your team already has more than 3 participants

Please indicate their respective universities

Do you have additional information to send us?

Please indicate their respective email addresses