Surname:.............................................
First Name:...................................................
Date of birth:...............................Nationality:.................................................................
Highest university degree obtained, year, name of institution:
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Institution presently associated with:................................................................................
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Present professional position and duties:..........................................................................
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Current fields of interest:...................................................................................................
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Mailing adress:.................................................................................................................
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Postcode:.....................................Place:.............................................................................
Country:............................................................................................................................
Phone:.......................................................Fax:.................................................................
E-mail:....................................................
Note that grants may cover all or parts of accommodation, and/or registration fee.
ACCOMMODATION AND REGISTRATION FEE:
I hereby request support for my accommodation from 25-30 November and for the registration fee.
STATEMENT BY THE APPLICANT
I hereby declare that the above information is correct and to the best of my knowledge. I understand that the grant may cover all or part of the total costs. I will acknowledge the European Union support especially if I need to obtain further support to attend the symposium, in which case, I will disclose the total amount of support I received from the EU.
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date and signature
STATEMENT BY THE INSTITUTION
The applicant is associated with our institution. His/Her postition is:
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date and signature/stamp
If you are a PhD student, please arrange for a letter of recommendation from your supervisor to be faxed or posted directly to the ddress below.
Very important: Your application for a GRANT will be considered only if this form is filled in completely and signed by you and your institution and the letter of recommendation (if you are a PhD student) has been received by us. Please print and fill in the form. If more space is needed attach an additional page.
You may fax or mail your application to us:
FAX: +44 131 451 8179
Fairouz Kamareddine, Symposium of Mathematic Knowledge Management, Heriot-Watt University, School of Mathematical and Computer Sciences, Riccarton, Edinburgh EH14 4AS, Scotland.
For more questions
Email:
Please note: DEADLINE FOR APPLICATION IS 25 October