WCRB 2017 SRF Bursary Application Form

CONTACT DETAILS AND ELIGIBILITY

The bursary scheme is available to Full, Early Career and Retired members who have held SRF membership for a minimum of the last 2 consecutive years (must have paid for 2016 and 2017). SRF Honorary members may also apply.

Title *

First Name *

Surname: *

Email Address *

Institution *

SRF Membership Category *

Full Member

Early Career Member

Retired Member

Honorary Member

Please enter your SRF Membership ID: *

WCRB 2017 Abstract Submission *

I am listed as the PRESENTING author on an abstract submitted for WCRB 2017

I am listed as a co-author on an abstract submitted for WCRB 2017

I am not listed as a presenting or co-author of any abstract submitted to WCRB 2017

Please provide your abstract submission number: *

This reference number will be found in the email from WCRB Organisers notifying you that your abstract has been successfully submitted.

Please enter the title of the abstract: *

Disclaimer *

I confirm that if I have to cancel my participation at WCRB 2017 I will notify the SRF Secretariat in writing at the earliest opportunity and will be liable to repay all or part of the funds to the SRF that have been paid over to me connected to the WCRB Bursary.

BURSARY PART 1 - REGISTRATION REQUIREMENTS

Please indicate the type of registration you will require for WCRB 2017. (Please note that by ticking this box you will not automatically be registered for the conference. Subject to your application being approved you will be contacted directly by the WCRB 2017 organisers to arrange your registration).

Please indicate the type of registration you will require for WCRB 2017. *

'Regular A' Category

'Student B' Category

Regular A = Full, Retired and Honorary Members / Student B = Early Career Members

Do you plan to attend the Conference Dinner/Banquet on Friday 29 September (please note this follows the close of the conference). *

Yes

No

BURSARY PART 2 - ACCOMMODATION

A fixed sum of £100/night for 4 nights (up to £400 for the entire meeting) will be available for all SRF Members.

Please indicate the number of nights you require. *

BURSARY PART 3 - TRAVEL

Travel support is offered on a fixed band system on distance from your place of work and will be calculated as follows: <10 km: £0; 10 - 100 km: £30; 100 - 300 km: £75; 300 - 500 km: £150; 500 - 750 km: £200; 750 - 1000 km: £300; 1000 - 3000 km: £400; 3000 - 6000 km: £600; 6000 - 9000 km: £800; >9,000km: £1000

Work address *

Town/City *

Postcode/Zipcode *

County/State

Country *

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CONTACT DETAILS AND ELIGIBILITY

BURSARY PART 1 - REGISTRATION REQUIREMENTS

BURSARY PART 2 - ACCOMMODATION

BURSARY PART 3 - TRAVEL

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