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− | == Registration form ==
| + | [[Workshop2013:registrationform]] |
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− | '''If you have already send this form, please do not send it again!'''
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− | In order to amend you application or with other queries please email ''gaiasciencealertsworkshop2013@gmail.com''
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− | {{#form: action=<nowiki>http://www.ast.cam.ac.uk/~wyrzykow/cgi-bin/mailer.cgi</nowiki> | method=post}}
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− | '''Contact details'''
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− | {|
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− | |Title (Mr/Mrs/Dr/Prof):
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− | | {{#input:type=textarea|name=dr|cols=5|style=width:auto|rows=1}}
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− | |Name:
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− | | {{#input:type=text|name=name}}
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− | |Affiliation:
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− | | {{#input:type=textarea|name=affiliation|cols=50|style=width:auto|rows=1}}
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− | |Work address:
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− | |{{#input:type=textarea|name=address|rows=3|cols=30|style=width:auto}}
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− | | Telephone:
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− | | {{#input:type=textarea|name=tel|value=don't forget your country code|cols=30|style=width:auto|rows=1}}
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− | |Email:
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− | |{{#input:type=textarea|name=email|rows=1|cols=20|style=width:auto}}
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− | |}
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− | {{#input:type=hidden|name=wabik}}
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− | ''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)''
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− | {{#input:type=textarea|name=research|rows=6|cols=100|style=width:auto}}
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− | ----
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− | {|
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− | | '''My contribution to the Workshop:'''
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− | |{{#input:type=select|name=contribution|
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− | *Please select
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− | *talk
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− | *poster
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− | *none}}
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− | |}
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− | {|
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− | | Title:
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− | | {{#input:type=textarea|name=title|rows=1|cols=100|style=width:auto}}
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− | | Brief abstract:
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− | | {{#input:type=textarea|name=abstract|rows=4|cols=100|style=width:auto}}
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− | |}
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− | ----
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− | '''Social Dinner'''
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− | ''We plan to have a workshop's dinner on'' '''''Thursday 20th'''''
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− | {|
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− | | I would like to participate in the dinner:
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− | | {{#input:type=select|name=dinner|
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− | *Please select
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− | *yes
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− | *no}}
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− | |}
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− | ----
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− | '''Other'''
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− | | Special dietary requirements (e.g. vegetarian, vegan):
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− | | {{#input:type=text|name=diet|value=No special dietary requirements}}
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− | |}
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− | {|
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− | | Disabled access:
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− | | {{#input:type=text|name=disabled|value=No special disabled requirements}}
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− | |}
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− | '''Funding'''
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− | 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.'''
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− | '''Now, make sure everything you entered is ok. If form is processed successfully you will receive a confirmation email.'''
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− | {{#input:type=submit|value=Send}}
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− | {{#formend:}}
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