Name and surname: _______________

Status (can select more than one)

• Bachelor degree student in _______________ (Physics, Maths etc.)
• Master degree student in _______________ (Physics, Maths etc.)
• PhD student in _______________ (Physics, Maths etc.)
• a professor/lecturer/instructor/teacher/researcher
• other please state _______________

Institution: _______________

E-mail (please give us your e-mail since we mainly communicate by e-mail): _______________

Phone: _______________

Please fill out the form and submit to burin.gumjudpai@physics.org

(TPCosmo II school participants neither need to submit this form nor pay any more fee)