CHAMA registration form, graduate, text format

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COMMISSION ON HISTORY OF ANCIENT AND MEDIEVAL ASTRONOMY (CHAMA) 

Application for Registration of Graduate Student Membership in CHAMA

Please email the completed form to jcasulleras@ub.edu or mail it to Josep Casulleras, Dept Filologia Sem�tica, Facultat de Filologia, Centre Ciutat, Pla�a Universitat, Edifici Hist�ric, GRAN VIA CORTS CATALANES, 585, 08007 BARCELONA, SPAIN.

Surname:*
Given Name:*
Country:*
Institution:*
e-mail:*
Professional Address, Telephone Number, Fax Number:*



Name, address, and email address of your supervisor or of a historian of ancient or medieval astronomy who is familiar with your work:

Research Field:*

Dissertation topic, publications, or other professional contributions:



Any Other Information:


Links:*

Date:

*Normally, this information  will be displayed on the CHAMA website. If you do not wish that  to appear on the site, it will be kept confidential. Please mention the exclusion specifically.