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:
Bâtiment Graaf de Ferraris,
11ème étage - Boîte 3
Boulevard du Roi Albert II, 20
1000 Bruxelles
Belgique
If you wish, you can also send in your contribution electronically to info@pianc.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 AUGUST 31
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Name: |
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Surname(s): |
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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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E-mail: |
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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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