XXXVIIth RENCONTRES DE MORIOND

Electroweak Interactions and Unified Theories

http://moriond.in2p3.fr/EW

Place :  Les Arcs, Savoie, France    Date : March 9-16 2002

 

APPLICATION FORM

I wish to apply for a European grant to attend the High Level Conference:

 

Partial support may be available for a limited number of young scientists (up to 35 years) who are nationals of a European Union Member* State or an Associated State and active inside a Member State or an Associated* State at the time of the event.

* On 28/09/01, Member States are: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, United Kingdom, and Associated States are: Bulgaria, Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, Slovenia, Iceland, Liechtenstein, Norway, Israel.

 

Name : ...............................................................

First name : .........................................................

Age : ..... Citizenship : ............................................

Professionnal status : ...............................................

University/Company : .................................................

Zip : ...... City : ..................  Country : ....................

Tel : ................................

Fax : ................................

E-mail : .............................................................

First University (or equivalent) graduation date : ............

Discipline : .....................................

Institution of graduation : ..........................................

Brief curriculum vitae since graduation : ............................

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Current or projected research activities and motives for wishing to attend the Euroconference :

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Do you or your research group hold a grant from which Euroconference participation 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.

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I declare the above truthful and sincere. I do not expect to be funded for Euroconference participation from other sources except as above, and that if awarded a grant by the Euroconference organisers, I will not cover any expenses from more than one funding source.

Date : ....................    Signed

Comments on benefit of participation from senior scientist (Supervisor, Department Head, etc.)

Name : ...................... Institution : ..........................

Position : .................. Relation with applicant : ..............

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Comments : ...........................................................

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Date : ..................... Signed :

Please return this form before December 30th, 2001 to

J. Tran Thanh Van - Rencontres de Moriond -

Universite de Paris-Sud - LPT - Batiment 210

91405 Orsay Cedex - France.

Fax : 33 (0)1 69 15 82 87