LongRange Workshop 2023 | Application form

Name

First

Last

Gender

Male

Female

Don't wish to say

We require this information for statistical purposes.

Email address

Home Address

Academic Affiliation

PI's Name

Address

City

State/Province/Region

Postal/Zip Code

Country

Education

Which position are you currently holding?

Master student

PhD student

Post-Doc

Permanent Scientific Staff/PI/Group Leader

Specialism

Experimentalist

Theorist

Currently unknown

Poster

There will be a poster session during the workshop. Participants are encouraged to present a poster related to their research.

Would you like to present a poster at the workshop?

Yes

No

Poster Category

What is the title of your poster? (if presenting a poster)

Shortly before the conference beginn we will select few poster applications for short-talks upgrade. Are you interested in this option?

Yes

No

Accommodation

We can provide a limited number of participants with support of up to 200 euros for accommodation.

Do you want to apply for a economical support for the accomodation?

Yes

No

Any additional information/comments

GDPR Compliance

We may use the information you provide using this form for administrative purposes related only to the Long-Range Interactions Workshop.

If you request that we provide you with accommodation, we may also share the details you provide with third-parties for the purpose of providing you with accommodation.

We will delete the personal information we hold about you within one year of the conclusion of the workshop.

I agree to my personal information being processed in the manner described above.