PIANC De Paepe – Willems Award application form
APPLICATION FOR THE
AWARD
This
form has to be completed and printed (click link in upper left corner of this
box). The printout needs to be returned by the candidate, together with his or
her article, to the General Secretariat of PIANC :
Graaf de Ferraris, 11th floor - Box 3
Blvd. du Roi Albert II, 20
1000 Brussels
Belgium
If you wish, you can also send in your contribution electronically to info@pianc-aipcn.org.
The same goes for the form below, provided that it is
sent as a scan and that your signature is on it.
CLOSING
DATE FOR RECEIPT OF ENTRIES IS 31 AUGUST
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Name
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Surnames
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Company
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Address
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City
& postal code : |
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Country
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Tel
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Fax
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Email
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Date
of birth : |
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Current
professional Activity : |
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Title
of article : |
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Approximate
number of words : |
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Number
of separate illustrations (if any) : |
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I certify that the
accompanying article has been written solely by me and
has not been published elsewhere. I have read and agree to be bound
by the rules of this competition. |
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Date
& signature |
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