Application for a European grant (doctorants)

XLIth RENCONTRES DE MORIOND
Electroweak Interactions and Unified Theories
Place : La Thuile, Aosta valley, Italy
March 11th -March 18th, 2006

Application Form (doctorants)






Mr  Ms  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 



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



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



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



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



Current or projected research activities and motives for wishing to



attend the conference :



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



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



Do you or your research group hold a grant from which



conference 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.



1...............................................................



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



2. ..............................................................



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



3. ..............................................................



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4. ..............................................................



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



5................................................................



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I declare the above truthful and sincere. I do not expect to



be funded for conference participation from other source



except as above, and that if awarded a grant by the



conference 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 : .............................................................. Comments : .................................................................. .................................................................. Date : ................. Signed :