I wish to apply for a Training and Mobility of Researchers grant to attend the event:

Taking place in Amsterdam, The Netherlands Date: 22-26 March 1999

Name:

First name:

Age:

Nationality:

Professional status:

University/Company:

Postcode:

City:

Country:

Tel:

Fax:

First University (or equivalent) graduation date:

Discipline:

Institute of graduation:

Brief curriculum vitae since 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

Have you applied for a grant for this purpose from any other body? Yes/no

If yes, what result?

Scientific publications of applicant (no more than 5, your best or most recent)

(Give title of paper, journal, volume and page numbers, authors)

Estimated costs of travel to the event (using most economical air or second class train fare)

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....................

(Optional)

Comments on benefit of participation from Supervisor, Department Head, etc.

Name:

Institution

Position:

Relation with applicant:

Comments:

Date Signature