WDAG'96 Student Certification

Please print this form, fill it out clearly and then

FAX To:		Italiana & Co.

Fax:	+39 51 222881
Tel:	+39 51 228716


		TO BE FILLED OUT BY THE ADVISOR


I certify that _________________________________ is a full-time

student in the ____________________________________ (Department)

at ____________________________________ (University). 


Name of Advisor: ________________________________________


Signature of Advisor: ___________________________________


		TO BE FILLED OUT BY THE STUDENT

Do you wish to be considered for sharing a
double room in a dormitory type accommodation
(subject to availability)?	[ ] Yes    [ ] No

Gender:				[ ] Male   [ ] Female