IEEE CSS TRAVEL SUPPORT FOR DEVE by fjzhangm

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									ASCC09 IEEE CSS TRAVEL SUPPORT FOR DEVELOPING COUNTRIES APPLICATION FORM
Last Name, First Name: Sex (Female/Male): IEEE Member No.*: CSS member*:
(yes/no)

Membership Status*:
(student member, member, senior member...)

Member since*:
(year)

Email: Department: Organization: Street Address: City, State, Zip: Country: Min. Income Status:
(yes/no)

Paper No. 1 (presented by the applicant): Title: Authors’ names: Paper Type:
(Regular, Invited, Short)

Session No.:
(see Acceptance Letter)

Additional papers: Number of additional papers: Paper(s) Details:
(Authors, Title, Type, Session No.)

Support received at previous conferences (if any): IEEE CSS support previously received:
(yes/no)

For which conference? Type of support:
(registration and/or cash amount – specify the amount)

*

IF AVAILABLE

IEEE CSS related activities (reviewer of IEEE CSS conference/journal papers, member of IEEE CSS
Conference/Journal Editorial Board, Chapter active member, etc):

Do you have IEEE CSS related activities?
(yes/no)

Description of these activities:

Support: Type of registration needed:
(regular/student. Note that student registration does not allow final paper upload)

Personal Statement: Reasons for requesting IEEE CSS travel support:

Any additional info you may want to give us:


								
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