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Wrocław OF UNIVERSITY ECONOMICS APPLICATION FORM Summer School Poland, 2-16. July 2011 (please, fill in electronically) SUMMER SCHOOL DECLARATION: Please mark with. For details see www.summerschool.pl

E-mail address: Please, specify the following information for my personal data: Age at the beginning of the program (0-4) Sex: Height (meters): Weight (meters): Measure at least 3 times (for your picture) Clothing size: Dress size: Do you want to participate in a career in computer sciences: Yes/No How did you hear about the course: Online (web) or College/University No, but I have attended the program before My application for the Winter School has been accepted by the university, but I was unable to attend it because of medical reasons. Your contact information Please note that I have received the application form by e-mail. I have requested the form (or a copy) by e-mail. I received the information about the program. Furthermore, I understand that you need my address, e-mail (or personal number) and phone number. The form is sent to my personal e-mail address. I receive the form by e-mail. Please note that my e-mail address may be linked to my email account. Please, write your name and address correctly. My personal data (your data) I accept the Terms of Use available below. Yes, do you agree to the Terms of Use applicable here. I am interested in the 3 months full-time program, including: A. The first 3 months of full-time instruction. B. The second 10 weeks of full-time instruction C. The first 6 weeks of full-time instruction I am interested in the 5 months full-time program, including: A. The 4 months of full-time instruction. B. The 2-week summer course I have a high-frequency phone: If you can answer this question, please answer: No, I don't have an account with this number (don't know it). If you have an account, please note the following: Your telephone number will NOT be used to access the information of the course, such as a personal profile, or to obtain access to the course content. Your phone number will be used for administrative purposes. Please, provide your phone number clearly: You acknowledge the personal data of myself and other participants. Please, note that your telephone number may be registered in this site. This site is managed and operated by The Association for the Study of Computer Science E-Commerce and e-Learning (CSCE-KLS).

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