Workshop2010:registrationform

From Gaia Science Alerts Working Group
Revision as of 10:57, 1 March 2010 by Lukasz (talk | contribs)

Jump to: navigation, search

Registration is not yet open!


{{#form: action=http://www.ast.cam.ac.uk/~wyrzykow/cgi-bin/mailer.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: 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|
  • none
  • talk
  • poster}}
Title: name=title|rows=1|cols=50|style=width:auto}}
Brief abstract: name=abstract|rows=4|cols=50|style=width:auto}}

Accommodation

I am interested in accommodation in nearby Churchill College name=accom_churchill|*yes
  • no, I'll find accommodation my self}}
Requested from date: name=accom_from|value=23/02/2010}} Check-out date: name=accom_checkout|value=25/02/2010}}
Room type: name=accom_roomtype|
  • single
  • double}}

Workshop's Dinner

We plan to host a workshop's dinner on Thursday 24th in one of the Cambridge colleges (King's, Trinity). The estimated cost would be 50 GBP.

I would like to participate in the dinner name=dinner|
  • yes
  • no}}

Financial support

We are able to provide limited support for travel and accommodation, mainly for students.

I would like to apply for the support: name=support|
  • yes
  • no|value=no}}
Justification: name=support_justification|rows=3|cols=50|style=width:auto}}

{{#input:type=submit|value=Send}}

{{#formend:}}