Workshop2010:registrationform

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{{#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|
  • talk
  • poster
  • none}}
Title: name=title|rows=1|cols=50|style=width:auto}}
Brief abstract: name=abstract|rows=4|cols=50|style=width:auto}}

Accommodation

We have booked a set of single and double rooms in the nearby Churchill College. If you are interested in this accommodation you will be asked to pay for your stay in advance. Alternatively you can book a room in one of the hotels or B&Bs in Cambridge. Check the Logistics page.

I would like to book a room in the Churchill College name=accom_churchill|
  • Please select
  • 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 Wednesday 23th in one of the Cambridge colleges. The estimated cost would be 50 GBP.

I would like to participate in the dinner: name=dinner|
  • Please select
  • 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:}}