Workshop2010:registrationform

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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): {{#input:type=textarea|name=dr|cols=5|style=width:auto|rows=1}}

Name: {{#input:type=textarea|name=name|cols=30|style=width:auto|rows=1}}

Affiliation: {{#input:type=textarea|name=affiliation|cols=50|style=width:auto|rows=1}}

Work address: {{#input:type=textarea|rows=3|cols=30|style=width:auto}}

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

Telephone (with international dial code): {{#input:type=textarea|name=tel|rows=1|cols=20|style=width:auto}}

Email: {{#input:type=textarea|name=email|rows=1|cols=20|style=width:auto}}

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Your contribution to the Workshop:	name=contribution| none talk poster}}
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

Requested from date:

name=accom_from|rows=1|cols=10|style=width:auto}}

Check-out date:

name=accom_checkout|rows=1|cols=10|style=width:auto}}

Room type:

name=accom_roomtype| single double}}

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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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