MaX prize for flagship codes application

TEMPLATE FOR PERSONAL INFORMATION ON APPLICANT(S)

APPLICANT #1
NAME ______________________________________________________________________________
FAMILY NAME________________________________________________________________________
INSTITUTION _________________________________________________________________________
CITY ___________________________________ COUNTRY ____________________________________
E-MAIL ADDRESS ______________________________________________________________________
DATE OF BIRTH _____________________________ GENDER ____M _____ F __________
DATE OF AWARD OF PHD ______________________________________________________________
ADDITIONAL RELEVANT INFORMATION, IN PARTICULAR IF THE SPECIAL CATEGORIES FOR PRIZE APPLY: (industrial researchers; women scientists and students; young researchers).
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
(Copy and paste as many times as needed, according to the number of applicants)