the abdus salam international centre for theoretical physics
Application Form for Scientific Meetings page 1
Application form for an:
In Person Meeting
1. Name and address of organizer (to be used in all correspondence):
Phone Cell E-mail
2. Type of Meeting (please tick the appropriate box):
Conference � Workshop � College/School �
3. Title of proposed meeting:
4. Location (specify institute, City, Country): Dates:
5. Organizing committee:
Director(s): Other members:
6. List main field/fields on which the activity will concentrate (specify PACS and or SC nos.):
Application Form for Scientific Meetings page 2
7. Detailed scientific programme
Name and Institution Topics/Title of lectures No. of hours Contacted Accepted
8. There will be yes no
- sessions for contributed papers
- posters sessions
- sessions on development problems related to the region, specifically:
Application Form for Scientific Meetings page 3
9. Describe the purpose and nature of the meeting:
10. Is this meeting part of a series of activities?
11. Is this activity part of a network? If not, will there be any special effort to encourage the
formation of regional scientific networks or professional societies?
12. Estimated number of participants:
From own country From the region From outside the region
Application Form for Scientific Meetings page 4
13. Outline of the scientific programme:
14. Level of activity: introductory, advanced, etc. Specify background of participants:
15. Describe any follow-up activity:
Application Form for Scientific Meetings page 5
16. Support requested from ICTP (not exceeding Euro 5,000): Amount in Euro
Travel expenses for invited speakers (other than host country)
Board and lodging expenses for speakers (other than host country)
Travel expenses for participants (other than host country)
Board and lodging expenses for participants (other than host country)
TOTAL
17. Income (other than requested from ICTP): received pending
Local funds
Other sources (specify):
18. Specify previous support received from ICTP/IAEA/UNESCO/TWAS programmes:
SIGNATURE OF ORGANIZER
(Before signing please be sure that all questions have been answered)
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Signature of Organizer Date
APPROVAL OF THE HEAD OF HOSTING INSTITUTE
Name and address of Head of Hosting Institute:
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Signature of Head Date