Workshop2010:registrationform

Registration form for invitees

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 gsaw2010@ast.cam.ac.uk

---

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

---

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}}

---

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.

I would like to book a room in the Churchill College

name=accom_churchill| Please select yes no, I'll find accommodation myself}}

Requested from date:

name=accom_from|value=23/06/2010}}

Check-out date:

name=accom_checkout|value=25/06/2010}}

Room type:

name=accom_roomtype| single at 60 GBP per night twin at 75 GBP per night}}

---

Workshop's Dinner

We plan to host a workshop's reception and dinner on Thursday 24th in one of the Cambridge colleges. The estimated cost would be 50 GBP.

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 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 euros). {{#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:}}