Computational Materials Design Workshop (CMD) Application Form
＜＜EXPERT COURSE＞＞
Please fill up the ff. form and submit it, by Fax AND E-mail, to: 
	CMD Secretariat, Graduate School of Engineering, Osaka University
	E-MAIL	: cmd@dyn.ap.eng.osaka-u.ac.jp
	FAX	: +81 6 6879 7859
Submission Deadline: 3 February 2008 (SUNDAY)
1.	NAME (Surname, Given Name) 
(Team Leader/Representative)	
	
2. Gender (Pls. mark with a ○)	 M　・　F          （＊lodging purposes）	
3. Affiliation  Name and Division
　　　　　  Street Address
            City
            State
            Postal Code
            Country
　　　　　  TEL
　　　　　  FAX
　　　　　  E-mail	

(     )         -
(     )         -
           @	
4. Previous participation 
(Pls. mark with a ○)	1st・2nd・3rd・4th・5th・6th・7th・8th・9th・10th・11th・12th CMD Workshop-Beginner Course
3rd・5th・6th・7th・8th・9th・10th・11th・12th CMD Workshop-Advanced Course
4th・5th・6th・7th・8th・9th・10th・11th・12th CMD Workshop-Expert Course	
5. Position　※		
6. Research Field/Interest		
7. Target Material		
8. Contact Address
(other than affiliation, optional)
　 
　　　　　  TEL
　　　　　  E-mail	

  (       )          -
             @	
9. Topic Proposal to Tackle During the Workshop
		
10. Please check the appropriate box on the right.	□：I am willing to join up with other participants having similar research interest.
□：I would like to work alone/with my own team.	
	
11. 
Team Members
	
NAME	
AFFILIATION	
POSITION	RESEARCH FIELD/TARGET MATERIAL	PREVIOUS CMD WORKSHOPS PARTICIPATED	

   Yes/No	

   Yes/No	
					
   Yes/No	

   Yes/No	
※In the field [5. Position], please answer: Prof., Assoc. Prof., M.S. Student (year), Ph.D. student (year) , etc.

1２. Summary of Proposed Topic (including prior preparation and expectation) 
(additional pages may be appended whenever necessary)