Lukasz at 20:51, 24 March 2014

2014-03-24T20:51:39Z

Lukasz at 20:49, 24 March 2014

2014-03-24T20:49:34Z

Lukasz: Created page with "== Registration form == '''If you have already send this form, please do not send it again!''' In order to amend you application or with other queries please email ''gaiascienc..."

2014-03-24T19:29:33Z

Created page with "== Registration form == '''If you have already send this form, please do not send it again!''' In order to amend you application or with other queries please email ''gaiascienc..."

New page

== Registration form ==

'''If you have already send this form, please do not send it again!'''

In order to amend you application or with other queries please email ''gaiasciencealertsworkshop2014@gmail.com''

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{{#form: action=<nowiki>http://www.ast.cam.ac.uk/~wyrzykow/cgi-bin/mailer.cgi</nowiki> | method=post}}

'''Contact details'''

{|
|-
|Title (Mr/Mrs/Dr/Prof):
| {{#input:type=textarea|name=dr|cols=5|style=width:auto|rows=1}}
|-
|Name:
| {{#input:type=text|name=name}}
|-
|Affiliation:
| {{#input:type=textarea|name=affiliation|cols=50|style=width:auto|rows=1}}
|-
|Work address:
|{{#input:type=textarea|name=address|rows=3|cols=30|style=width:auto}}
|-
| Telephone:
| {{#input:type=textarea|name=tel|value=don't forget your country code|cols=30|style=width:auto|rows=1}}
|-
|Email:
|{{#input:type=textarea|name=email|rows=1|cols=20|style=width:auto}}
|}

{{#input:type=hidden|name=wabik}}

''Please give a short description of your current research and research interests, as well as a description of how you will contribute to and benefit from the workshop (<400 words)''
{{#input:type=textarea|name=research|rows=6|cols=100|style=width:auto}}

----
{|
|-
| '''My contribution to the Workshop:'''
|{{#input:type=select|name=contribution|
*Please select
*talk
*none}}
|}

{|
|-
| Title:
| {{#input:type=textarea|name=title|rows=1|cols=100|style=width:auto}}
|-
| Brief abstract:
| {{#input:type=textarea|name=abstract|rows=4|cols=100|style=width:auto}}
|}

----
'''Social Dinner'''

''We plan to have a workshop's dinner on'' '''''Wednesday 10th'''''

{|
|-
| I would like to participate in the dinner:
| {{#input:type=select|name=dinner|
*Please select
*yes
*no}}
|}
----
'''Other'''

{|
|-
| Special dietary requirements (e.g. vegetarian, vegan):
| {{#input:type=text|name=diet|value=No special dietary requirements}}
|}
{|
|-
| Disabled access:
| {{#input:type=text|name=disabled|value=No special disabled requirements}}
|}

----
'''Funding'''

Should you request any funding support, please email us directly with a justification and an estimate of the travel and accommodation costs. The support is available primarily for students and postdocs.'''

----
'''Now, make sure everything you entered is ok. If form is processed successfully you will receive a confirmation email.'''
----

{{#input:type=submit|value=Send}}

{{#formend:}}

@@ Line 7: / Line 7: @@
 ----
-{{#form: action=<nowiki>http://www.astrouw.edu.pl/ּּ~wyrzykow/exec/mailer.cgi</nowiki> | method=post}}
+{{#form: action=<nowiki>http://www.astrouw.edu.pl/~wyrzykow/exec/mailer.cgi</nowiki> | method=post}}
 '''Contact details'''

Workshop2014:registrationform - Revision history

Lukasz at 20:51, 24 March 2014

Lukasz at 20:49, 24 March 2014

Lukasz: Created page with "== Registration form == '''If you have already send this form, please do not send it again!''' In order to amend you application or with other queries please email ''gaiascienc..."