1. IAU Symposium/Colloquium Number:
2. IAU Symposium/Colloquium Title:
3. Location:
2. Dates of meeting:
| 3. Applicant | Name: | Surname: |
| Position: |
| Citizenship: | Age: | Sex: |
| Address: | |||||
| Tel.: | Fax : | E-mail: | |||
4. Type of contribution (e.g. review talk, thesis presentation, poster, .....):
5. Title of contribution:
6. Amount of IAU support (in CFH) requested, for subsistence only:
7. Other sources of support applied to and amount requested:
8. Signature of applicant:
Date & place:
9. For Ph.D. students:
Name and signature of Thesis Director/Supervisor:
Institution:
This Form, or one including the same essential information, should be submitted to the Chairperson of the Scientific Organising Committee by the specified deadline (see the paragraph on Grants to IAU-sponsored meetings in Rules for IAU Sponsored Scientific Meetings).