Workshop2010:registrationform

Registration is not yet open!

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{{#form: action=http://www.ast.cam.ac.uk/~wyrzykow/cgi-bin/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:	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}}

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My contribution to the Workshop:	name=contribution| talk poster none}}
Title:	name=title|rows=1|cols=50|style=width:auto}}
Brief abstract:	name=abstract|rows=4|cols=50|style=width:auto}}

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Accommodation

I am interested in accommodation in nearby Churchill College

name=accom_churchill|*yes no, I'll find accommodation my self}}

Requested from date:

name=accom_from|value=23/02/2010}}

Check-out date:

name=accom_checkout|value=25/02/2010}}

Room type:

name=accom_roomtype| single double}}

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Workshop's Dinner

We plan to host a workshop's dinner on Wednesday 23th in one of the Cambridge colleges. The estimated cost would be 50 GBP.

I would like to participate in the dinner

name=dinner| yes no}}

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Financial support

We are able to provide limited support for travel and accommodation, mainly for students.

I would like to apply for the support:	name=support| yes no|value=no}}
Justification:	name=support_justification|rows=3|cols=50|style=width:auto}}

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

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