Difference between revisions of "Workshop2013:registration"

From Gaia Science Alerts Working Group
Jump to: navigation, search
(Reg form installed)
 
(Replaced content with "Workshop2013:registrationform")
Line 1: Line 1:
== Registration form ==
+
[[Workshop2013:registrationform]]
 
 
'''If you have already send this form, please do not send it again!'''
 
 
 
In order to amend you application or with other queries please email ''gaiasciencealertsworkshop2013@gmail.com''
 
 
 
----
 
 
 
{{#form: action=<nowiki>http://www.ast.cam.ac.uk/~wyrzykow/cgi-bin/mailer.cgi</nowiki> | method=post}}
 
 
 
'''Contact details'''
 
 
 
{|
 
|-
 
|Title (Mr/Mrs/Dr/Prof):
 
| {{#input:type=textarea|name=dr|cols=5|style=width:auto|rows=1}}
 
|-
 
|Name:
 
| {{#input:type=text|name=name}}
 
|-
 
|Affiliation:
 
| {{#input:type=textarea|name=affiliation|cols=50|style=width:auto|rows=1}}
 
|-
 
|Work address:
 
|{{#input:type=textarea|name=address|rows=3|cols=30|style=width:auto}}
 
|-
 
| Telephone:
 
| {{#input:type=textarea|name=tel|value=don't forget your country code|cols=30|style=width:auto|rows=1}}
 
|-
 
|Email:
 
|{{#input:type=textarea|name=email|rows=1|cols=20|style=width:auto}}
 
|}
 
 
 
{{#input:type=hidden|name=wabik}}
 
 
 
''Please give a short description of your current research and research interests, as well as a description of how you will contribute to and benefit from the workshop (<400 words)''
 
{{#input:type=textarea|name=research|rows=6|cols=100|style=width:auto}}
 
 
 
----
 
{|
 
|-
 
| '''My contribution to the Workshop:'''
 
|{{#input:type=select|name=contribution|
 
*Please select
 
*talk
 
*poster
 
*none}}
 
|}
 
 
 
{|
 
|-
 
| Title:
 
| {{#input:type=textarea|name=title|rows=1|cols=100|style=width:auto}}
 
|-
 
| Brief abstract:
 
| {{#input:type=textarea|name=abstract|rows=4|cols=100|style=width:auto}}
 
|}
 
 
 
----
 
'''Social Dinner'''
 
 
 
''We plan to have a workshop's dinner on'' '''''Thursday 20th'''''
 
 
 
{|
 
|-
 
| I would like to participate in the dinner:
 
| {{#input:type=select|name=dinner|
 
*Please select
 
*yes
 
*no}}
 
|}
 
----
 
'''Other'''
 
 
 
{|
 
|-
 
| Special dietary requirements (e.g. vegetarian, vegan):
 
| {{#input:type=text|name=diet|value=No special dietary requirements}}
 
|}
 
{|
 
|-
 
| Disabled access:
 
| {{#input:type=text|name=disabled|value=No special disabled requirements}}
 
|}
 
 
 
----
 
'''Funding'''
 
 
 
Should you request any funding support, please email us directly with a justification and an estimate of the travel and accommodation costs. The support is available primarily for students and postdocs.'''
 
 
 
 
 
----
 
'''Now, make sure everything you entered is ok. If form is processed successfully you will receive a confirmation email.'''
 
----
 
 
 
{{#input:type=submit|value=Send}}
 
 
 
{{#formend:}}
 

Revision as of 14:25, 19 April 2013

Workshop2013:registrationform