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XXXVIIIth RENCONTRES DE MORIOND
QCD AND HIGH ENERGY HADRONIC INTERACTIONS
http://moriond.in2p3.fr/QCD/2003/
Place :  Les Arcs, Savoie, France    Date : March 22-29, 2003

Application for a Grant

(participants from an Eastern Europe Country)

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 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...............................................................
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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 :
Please return this form before November 30th, 2002
- Rencontres de Moriond -
Universite de Paris-Sud - LPT - Batiment 210
91405 Orsay Cedex - France.
Fax: 33-1 69 15 82 87 or
E-mail: claude.barthelemy@th.u-psud.fr