Application form for participation in the kse students and Teaching Conference “regional development

APPLICATION FORM

For participation in the KSE Students and Teaching Conference


“REGIONAL DEVELOPMENT –

SMALL PIECES OF A BIG SUCCESS”


to be held on April 9-10, 2011 in Kyiv.


Application Deadline: March 1, 2011 to conference@kse.org.ua


The application form should be submitted together with your essay, research paper or presentation. Please indicate in your message which category (essay, research paper or presentation) you are applying to. The best essays and research papers will be presented at the KSE Students and Teaching Outreach Conference to be held on April 9-10, 2011 in Kyiv.

Name:

Current Address: Address Postcode____________

City Country

^

Contacts: Telephone numbers_(home) (office)

Mobile phone E-mail

Alternative phone number where a message may be left for applicant

Education: University

Department

Major(s) (if declared)

Year of study

Which diploma was obtained or is expected

Occupation: Employing Institution/Organization

Position


Research Supervisor: Name _______

Organization _

Position ______________

Scientific Degrees ____________________

E-mail ______________


Previous Conference

Experience: [ ] None [ ] One [ ] Two [ ] Three or more

Proposed Title of

Presentation:

What conference equipment do you need for presentation?

__________________________________________________________________________________

__________________________________________________________________________________

Do you need a hotel during your stay in Kyiv?

[ ] Yes [ ] No If you answer Yes, please indicated the Date/Time of your stay [start -end].

Please note that KSE will be able to reimburse 1 night in the hotel only.

What is the cost of your transportation to Kyiv (train-kupe for participants from Ukraine, Belarus and Moldova)?

Indicate your total estimated transportation cost in UAH [ ]


Note the source from which you received information about the conference:

_______________________________________________________________________________

Thank you very much for the completed application form!