Society for Reproduction and Fertility - Travel Grant Application

Please complete this form for consideration by the Grants Committee. Applicants should ensure that their subscriptions to SRF for the current year have been paid, as applications cannot be processed until this has been done.

Applicants can receive a maximum of £375 in any 2 year period. Applications must be submitted in advance of the event to which they relate, and grants will normally be made in advance. All grants will be paid in £'s sterling. A short report is required on the usefulness of the meeting. Applicants are required to have paid their current Society membership subscription.



Your Title:	*
Your First Name:	*
Your Surname:	*

Company/Organisation:
Department:
Address:	*
Town/City:	*
Postcode/Zipcode:
County/State:
Country:	*

Telephone No:	*
Fax No:
E-mail address:	*
SRF member status*:	Statutory Member Non-Statutory Member

Current status:
Post-graduate student - Year 1:
Post-graduate student - Year 2:
Post-graduate student - Year 3:
Post-graduate student - Year 4 or greater:
Post-doctoral research fellow:
Salaried member of staff:
Other:		(please specify below)


SECTION 1 - TRAVEL GRANT
(a) Meeting Details
Name of Conference/Symposium/Workshop:


Place:
Dates:
Organisers:
Details of applicant's participation:
Poster Presentation:	Title:
Oral Presentation:	Title:
Invited Paper:	Title:
Session Chair:	Session Title:
Delegate, not Presenting:

(b) Supplementary Information - Details of any other meetings planned with colleagues or other anticipated benefits to your work:

SECTION 2 - EXPENSES
Please give full details (costs in UK Pounds Sterling)

Cost of Travel

from:	to:	cost (UK Pounds)
Flight:
Train:
Car:
Other:

Cost of Subsistence

Bed & Breakfast - No. of Nights:		Cost:
Lunch(es) - No. of Days:		Cost:
Dinner(s) - No. of Days:		Cost:

Congress Fee

Details:

Cost:

TOTAL COSTS:

Amount requested by the applicant:

SECTION 3: APPLICATIONS FOR GRANTS FROM OTHER SOURCES
(This section must be completed, especially item C)
(a) Details of support offered from other sources

(b) Details of other applications pending (include the date when the outcome will be known):

(c) Reasons why support from own University or Institute is not forthcoming:

SECTION 4: CONTACT DETAILS
Head of School/Department/Division at Host Institution Your Head of Department is required to verify the information supplied. Please complete his/her contact details below. If you are the Head of Department please nominate the Administrative Officer of the Institution.

		If you are the Head of Department please tick

	Name:	*
	Position:
	E-mail address:	*
	Confirm E-mail:	*


Please check your entries carefully before pressing submit. Make sure that you have given the correct details for all the contacts required. Your application cannot be considered without these details.
	Confirm your E-mail:	*


* indicates a compulsory field