Financial Support Form for Eastern European Scientists

RENCONTRES DE MORIOND
The Cosmological Model
March 16-23, 2002 , Les Arcs, Savoie, France

Please return this form before December 30th, 2001 to:
J. Trân Thanh Vân - Rencontres de Moriond
Université de Paris-Sud
LPTHE - Batiment 210
91405 Orsay Cédex - France. Fax : (33 1) 69 15 82 87
or E-mail: claude.barthelemy@th.u-psud.fr
and copy to: wrzesins@lal.in2p3.fr


DEADLINE FOR APPLICATION : DECEMBER 30th, 2001

I wish to apply for an European Union grant to attend the
Euroconference : The Cosmological Model
Les Arcs, France  March 16-23, 2002

Name : ...............................................................  
First name : .........................................................
Date of birth : ............      
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 conference :
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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 : ..................................................
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Scientific publications of applicant (not more than 5, your best or most 
recent) Give title of paper, journal, volume and page numbers, authors.

1. .......................................................................
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I declare the above truthful and sincere. I do not expect to be funded for 
conference participation from other sources except as above, and if 
awarded a grant by the conference organisers, I will not cover any 
expenses from more than one funding source.

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