APPLICATION to enter the EURO-SEAD COURSE 2006/07 Family Name Given Name Address for correspondence Telephone number Telexfax number Email address Nationality: Age: Sex: Qualifications (give details) TECHNICAL (Name of Degree) What is the broad technical discipline? (please tick whichever is appropriate): Mechanical Electrical/Electronics Chemical Biotechnical Other LEGAL   PATENT   Standard of English (please tick whichever is appropriate) ORAL:      very good          good          fair WRITTEN:   very good       good       fair Current Employment Details (give details) Employer's Name: Employer's Address: Previous Patent Courses attended Knowledge of Patent Law and how obtained (include length of time exposed to patents) Why course would be of value to you Name and Address of Sponsor (that is of the person responsible for payment of registration fees) Please return this form by OCTOBER 10, 2006 to: Dr. Axel von Hellfeld Vice-President Training and Education Commission (FICPI) Wuesthoff & Wuesthoff Schweigerstrasse 2 81541 München GERMANY Telephone: +49-89-62 18 00-0 Facsimile: +49-89-62 18 00-15 Email: hellfeld@wuesthoff.de On acceptance to the Course, I 1. agree to attend both tutorial sessions 2. agree to pay the registration fees of EUR 3000 3. agree to pay for my accommodation (incl. breakfast) - Euro 135 + VAT per day 4. understand that FICPI may at its sole discretion cancel my involvement in the course and return my registration fees. 5. note that I will pay my own travel expenses SIGNED ............................  DATE..................... Do not send any money until you have been notified of acceptance to the Course.