Go InternationalRegistration Staff Week Registration Staff WeekWith this online form you register for the selected international event. NOTE: Please fill in the form COMPLETELY, before you send this to us.Registration Staff WeekEvent*02.12. - 05.12.2019 - Staff Week on International Cooperation Vienna Personal data Family name* First name* Date of birth* Sex* female male - Phone (incl. country and area code)* E-Mail* Home Address Street* Postal Code* City* Nationality* Emergency contact (e.g. parents, close friend, …)* Further things useful to know for us (special diet, etc.) Home Institution Official name and address of your home university / institution* Department Your International coordinator Name coordinator* Approval international coordinator* no yes Phone coordinator* E-Mail coordinator* Main focus Subjects of Interest* Colleagues you would like to meet Scientific Department* Language competence Mother tongue* English language competence*poor ( )fair ( )good ( ) German language competence*poor ( )fair ( )good ( ) The participant attests that s/he has a health insurance and a public liability insurance so that costs for a doctor / hospital abroad and costs for damages to a third party will be covered. Don't fill this field!