MEDIAZIONI E MEDIATORI CULTURALI /LES MEDIATIONS ET MEDIATEURS CULTURELS (MMC), Padova, Italia - 12th-17th of June 2017

1. Surname and name:

2. Address (residence):

3. Mailing address:

4 .Phone number:

5. e-mail:

6. Place and date of birth:

7. Nationality:

8. Qualification:

9. PhD thesis title:

10. University campus:

11. Name of thesis supervisor:

Please send this form, together with a scan of your identity document, to: summerschool.dissgea@unipd.it