Workshop2012:registrationform

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 gsawg@ast.cam.ac.uk

---

{{#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:	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| Please select talk poster none}}

Title:	name=title|rows=1|cols=100|style=width:auto}}
Brief abstract:	name=abstract|rows=4|cols=100|style=width:auto}}

---

Arrival/departure

Please provide us with the dates of your arrival/departure to/from Cambridge:

Arrival:

name=arrival|value=28/06/2011}}

Departure:

name=departure|value=01/07/2011}}

---

Accommodation

We have booked a set of single and double rooms in the nearby Churchill College. If you are interested in this accommodation you will be asked to pay for your stay in advance. Alternatively you can book a room in one of the hotels or B&Bs in Cambridge. Check the Logistics page.

• Please select
• yes
• no, I'll find accommodation myself}}

I would like to book a room in the Churchill College from 28/06 to 01/07 (contact us if you need to book for other dates)

name=accom_churchill|

Room type:

name=accom_roomtype| single at 58 GBP per night twin at 72 GBP per night}}

---

Workshop's Dinner

We plan to have a workshop's dinner on Thursday 30th in the St.John's Chop House restaurant.

I would like to participate in the dinner:

name=dinner| Please select yes no}}

---

Other

Special dietary requirements (e.g. vegetarian, vegan):

name=diet|value=No special dietary requirements}}

Disabled access:

name=disabled|value=No special disabled requirements}}

---

Financial support

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

I would like to apply for the support:

name=support| no yes}}

Brief (<250 words) justification of your need for financial support. Please include amount of money you would like to apply for (in pounds). {{#input:type=textarea|name=justification|rows=3|cols=100|style=width:auto}}

---

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:}}