Name:
First name:
Age:
Nationality:
Professional status:
University/Company:
Postcode:
City:
Country:
Tel:
Fax:
First University (or equivalent) graduation date:
Discipline:
Institute of graduation:
Current or projected research activities and motives for wishing to attend the conference:
Do you or your research group hold a grant from which participation in the event could be funded? Yes/no
Scientific publications of applicant (no more than5, your best or most recent)
Estimated costs of travel to the event (using most economical air or second class train fare)
FROM | TO | Means of transport | Return/Single | COST |
I declare the above truthful and sincere. I do not expect to be )funded for participation in the event from other sources except as above, and that if awarded a grant by the organisers of the event, I will not cover any expenses from more than one funding source.
Signed | Date |
(Opional)
Comments on benefit of participatin from Supervisor, Department Head, etc.
Name:
Institution:
Position:
Relation with applicant:
Comments:
Date | Signature |