Nomination of candidate to Nils Klim Prize 2013

Candidate:

Name (last name, first name) *

Date of birth

Position *

Institution

E-mail address *

Postal address

Brief statement justifying the nomination (2-3 pages - please upload a file) *

CV (including the candidate's main publications and other scholarly achievements - please upload a file) *

Candidate's homepage

Reference persons who know the candidate and his or her work *

Nominator:

Name (last name, first name) *

Position *

Institution

E-mail address *

Postal address

Telephone *

Additional information (please upload a file)

Where did you learn of the possibility to nominate candidates (optional)?

Agreement: As a nominator I agree to not publicise the names of nominees nor inform nominees privately of their proposal. *