*Please Complete This Form Clearly, Using BLOCK CAPITALS

*Please complete this form clearly, using BLOCK CAPITALS 2011 Bursary Application Form*

Event: Connecting structure to function: from experiment to calculation and back again Hosted by the Molecular Graphics and Modelling Society (MGMS) and the University of Cambridge, 19th – 21st September 2011, Downing College, Cambridge

Full name of applicant:

Name of organisation/institution:

Department/Faculty:

Job Title (where relevant):

Title of course / Qualification you are studying towards:

Please explain why you wish to attend this event and how it is relevant to your studies / work. (maximum 100 words):

Would you like to attend the gala evening dinner on 20th September? Y / N

Please state any special dietary requirements:

Please estimate the value of your bursary below. *Please be as economical as possible as unrealistic applications will be rejected

How do you intend to travel? (eg car, train):

Where will your journey start? (please provide town/city or postal code): Registered office: 22-23 Blenheim Terrace, Woodhouse Lane, Leeds, LS2 9HD, UK Tel: +44 (0) 113 394 6020 www.lhasalimited.org | [email protected] | VAT number 396 8737 77 | Registered Charity 290866 Company Registration Number 01765239 (England and Wales)

Lisa Wayman Page 1 of 3 Version 1: August 2010 Estimated distance (miles): Estimated travel cost:

Do you require accommodation? Y / N

Please advise the dates for which you require accommodation (the bursary covers a maximum of 2 nights). Accommodation will be booked on your behalf by Lhasa Limited.

Monday 19th September Tuesday 20th September

Please type here any further information you would like to share in support of your application.

I wish to apply for a bursary for attending: Connecting structure to function: from experiment to calculation and back again, hosted by the Molecular Graphics and Modelling Society (MGMS) and the University of Cambridge, 19th – 21st September 2011, Downing College, Cambridge.

I agree to write a report (minimum 500 words) on the event, which will be sent to Lhasa Limited within three weeks of attending the event, along with evidence of my travel expenditure (eg receipts/ confirmation). I have read and agree to the terms and conditions of the Lhasa Limited Bursary Scheme.

______Signature of applicant Date

I support the above application for a bursary to attend this event.

______Signature of line manager/tutor Please print name

Please return your completed form by 31st July 2011

Post: Chris Richardson, MGMS, c/o BioFocus, Chesterford Research Park, Saffron Walden,Essex, CM10 1XL

Email: [email protected]

Registered office: 22-23 Blenheim Terrace, Woodhouse Lane, Leeds, LS2 9HD, UK Tel: +44 (0) 113 394 6020 www.lhasalimited.org | [email protected] | VAT number 396 8737 77 | Registered Charity 290866 Company Registration Number 01765239 (England and Wales)

Lisa Wayman Page 2 of 3 Version 1: August 2010 Applications will be shared between the co-organisers and LHASA Limited

Prior to the event Lhasa Limited will inform applicants whether they have been successful. Costs will usually be reimbursed after the event, when we have received your report and travel expenses claim (receipt/confirmation). Payment may only be made in advance where there is a strong case for this.

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