Application Form for Travel Support 15Th Globelics Conference, Athens, Greece, 2017

Application form for Travel Support 15th Globelics Conference, Athens, Greece, 2017

To apply for travel support, please follow the steps below:

1) Carefully read the application requirements for travel support on http://2017.globelics.org/under “Travel Support” page. By applying through this application form you agree with the regulations on travel support specified on the conference homepage. 2) Fill out the ConfTool travel support submission (once your paper is submitted) by accessing your ConfTool user account. The application deadline is the same as the paper-submission deadline – April 30, 2017. 3) Download, complete and sign this application form. Upload it to your ConfTool travel support submission.

Personal information Full name (First, middle, last) As written in passport! Gender (M/F): Nationality: Address: City: State/Region: Postal or Zip Code: Country : Country of origin : Email address Passport number

Affiliation University affiliation (or organization) Position (PhD student, researcher, professor) Title of paper

Paper id number (You can find the number under ‘your submissions’ in Conftool).

of 2 Request Airfare / Itinerary From: City name/airport

Via: City name /airport(s)

To: City name /airport

Estimated travel costs in EUR

Additional Information

Please note: You are obliged to send all original ticket stubs and boarding passes by post to the GLOBELICS secretariat AFTER the conference within a maximum of 7 days from return to your original destination. All original documentation should be scanned before mailing them as an extra precaution.

Mailing address: Avenida Pasteur, 250 – Sala 107 Urca – Rio de Janeiro – Brasil CEP: 22290-240

I hereby confirm that I have read, understand and agree with the requirements for travel support on http://2017.globelics.org/travel-support/. If I get support for the travel, I will send all receipts and ticket stubs to Globelics Secretariat within a maximum of 7 days from return my original destination.

Date: ______Signature: ______

Please note that if you receive travel support, you are obliged to participate in a post-conference internet-based survey conducted by the Globelics Secretariat. The purpose is to collect information in order to evaluate and improve the activities of the Globelics community.