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									                    49th Culham Plasma Physics Summer School
                                16th – 27th July 2012

                                                  APPLICATION FORM
                                    Closing date for registration: 1st June 2012
                                Discount for early registration before 30th April 2012

PLEASE TYPE OR USE BLOCK CAPITALS

Title:       Dr                   Mr                     Ms                              Male                        Female

Surname: ....................................................                     Forenames: ..........................................

Nationality: .................................................                    Passport No. : ......................................

Date of Birth: ..............................................                     Place of Birth: ......................................

Please note that the CCFE does not qualify for student or educational visas. Advice
should be taken from the UK Borders Agency or the UK Embassy or Consulate closest to
you, as to which category of visa should be applied for.

RESIDENT ADDRESS (where the applicant is currently living):

 .....................................................................................................................................................
 ......................................................................................................................................................


Telephone No:               ..........................................            Fax No:          ...............................................

E-mail address (in full):                 .......................................................................................................

Qualifications: please state University and description of degree with class and dates:

 .....................................................................................................................................................
 ......................................................................................................................................................
  .

Research interests:
......................................................................................................................................................

 …………………………………………………………………………………………………………….

 …………………………………………………………………………………………………………….




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Address of present work/study:

    ....................................................................................................................................................

    ....................................................................................................................................................


.
    STATUS:               PhD                   MASTERS                       Staff                  Other –
                                                                                                     Please specify



Supervisor/Sponsor Details: Please give name, status, address and email address of the
supervisor whom you are asking to support this application:

Name: .........................................................................................................................................

Status: .........................................................................................................................................

Address: .......................................................................…………….............................................

.....................................................................................................……………..........….................

Email address: .............................………………………………………………………....................

Telephone No: ...........……………………………………………...…………………………………..


Poster Session

I plan to present a poster                        I do           I do not plan to present a poster

Accommodation
The Accommodation Fee of £462 covers your bed and breakfast for a single room from arrival
on the evening of Sunday 15th July to the morning of Friday 27th July inclusive. The final lecture
of the Summer School ends at 13.00 on Friday 27th July, transport from Culham to Oxford rail
and bus stations departs Culham at 14.00.
Additional night(s) required AFTER the Summer School may be available upon request at the
extra cost of £31.00 per night/per student on a room only basis.

Accommodation Requirements:

I require accommodation                                                  I do NOT require accommodation

Date of arrival: ........................................... Date of departure: .................................

Number of additional night(s) required: …………


Vegetarian meals are available – please tick if required :




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                                             Registration/Accommodation Fees
NO BANK TRANSFERS TO BE MADE UNTIL APPLICATION IS ACCEPTED.

Please ensure that bank transfers will not result in a charge to the Summer School.

LATE CANCELLATION CHARGES ALSO APPLY. ALL SECTIONS MUST BE COMPLETED.

Please indicate fees payable (tick as appropriate):       On or before 30th April                                             After 1st May
                                                                    £320                                                        £375
Registration Fee: £320 before 30th April - £375 after 1st May
(includes Lunch every day at Culham)

Accommodation Fee: £462 (Bed & Breakfast only)

Additional nights required at £31.00 per night (room only basis)

Payment by credit card will incur an additional charge of 3.5% on the above fees

TOTAL AMOUNT PAYABLE:                                   £……………………………

Please indicate by which method you will be paying:

                      By bank transfer to:              Royal Bank of Scotland
                                                        Thurso Branch, 11 Olrig Street, Thurso, KW14 7BL
                      Account No:                       00102300
                      Sort Code:                        83-27-23
                      IBAN:                             GB54RBOS83272300102300
                      Swift/BIC:                        RBOSGB2LXXX
                      In favour of:                     UK Atomic Energy Authority
                                                        REF: SS2011 & NAME OF STUDENT

                      By sterling cheque made payable to UK Atomic Energy Authority enclosed
                      with application form.

                      By Debit/Credit card - Additional fees will apply to credit cards. (No fees apply to
                      UK Debit cards).

For Card payments, please contact Kathy.Patton@ccfe.ac.uk

For EU countries only:
Customer VAT registration Number: ........................................................................................


Finance administration: State the Name and address of the University, Institution,
Company or person who will pay all fees (where the INVOICE should be sent):

Name: .......................................................................................................................................

Address: ……………………………………………………………………………………………….

…………..………………………………………………………………………………………………

Telephone No.: .........................................................................................................................

Email Address to send invoice to: ..............................................................................................


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Signature of Applicant: .........................................................................................................

Signature of Supervisor/Sponsor: ...........................................................................................


Please return application form and payment to:

UK Atomic Energy Authority
Kathy Patton - Summer School Administrator
EURATOM/CCFE Fusion Association
Culham Science Centre
Abingdon, Oxon
OX14 3DB, UK

Tel: (+44) 1235 466635
Fax: (+44) 1235 466379
Email: kathy.patton@ccfe.ac.uk




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