Please take the time to fill in all applicable entry fields! Any forms not fully filled in will not be processed by our server, so please make sure you have completed every question. In particular you must click on the bullets of question 8.

Both the organizer and the head of the hosting institution must send signed letters to the OEA stating that they confirm that the proposed meeting is authorized by them.

1. Name of Organizer

   Address

   Phone Fax e-mail




2. Type of Meeting: Select the Type of Meeting Conference Workshop College/School




3. Title of proposed Meeting




4. Location (Specify Institute)

   Dates




5. Organizing Committee:

   Other Members:




6. List main field(s) on which the activity will concentrate:

   Main PACS numbers

   or

   Mathematics Subject Classification numbers




7. Detailed scientific programme

   Name and Institution	Topics/Title of Lectures	No. of hours	Contacted	Accepted




8. There will be:

   	Yes	No
   Sessions for contributed papers
   Poster sessions
   Sessions specifically on development problems in the region




9. Describe the purpose and nature of the meeting:




10. Is this meeting part of a series of activities?:




11. Is this activity part of a network? If not, will there be any special effort to encourage the formation of regional scientific networks or professional societies?:




12. Estimate the total number of participants:

    From own country From the region From outside the region




13. Outline of the scientific programme:




14. Level of activity: introductory, advanced etc. Specify background of participants:




15. Describe any followup activity:




16. Support requested from the ICTP in euros (not exceeding 5000 euros)

    Travel expenses for invited speakers (other than host country)
    Board and lodging expenses for speakers (other than host country)
    Travel expenses for participants (other than host country)
    Board and lodging expenses for participants (other than host country)
    Total




17. Income other than that requested from the ICTP

    	recieved	pending
    local funds
    Other sources specify:




18. Specify previous support recieved from ICTP/IAEA/TWAS/UNESCO programmes