Difference between revisions of "Workshop2014:registrationform"
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− | {{#form: action=<nowiki>http://www.astrouw.edu.pl/ | + | {{#form: action=<nowiki>http://www.astrouw.edu.pl/~wyrzykow/exec/mailer.cgi</nowiki> | method=post}} |
'''Contact details''' | '''Contact details''' |
Latest revision as of 20:51, 24 March 2014
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
{{#form: action=http://www.astrouw.edu.pl/~wyrzykow/exec/mailer.cgi | method=post}}
Contact details
Title (Mr/Mrs/Dr/Prof): | name=dr|cols=5|style=width:auto|rows=1}} |
Name: | name=name}} |
Affiliation: | name=affiliation|cols=50|style=width:auto|rows=1}} |
Work address: | name=address|rows=3|cols=30|style=width:auto}} |
Telephone: | name=tel|value=don't forget your country code|cols=30|style=width:auto|rows=1}} |
Email: | 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: | name=contribution|
|
Title: | name=title|rows=1|cols=100|style=width:auto}} |
Brief abstract: | 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: | name=dinner|
|
Other
Special dietary requirements (e.g. vegetarian, vegan): | name=diet|value=No special dietary requirements}} |
Disabled access: | 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:}}