Family Name:

First Name:

Middle Initial(s)

Male/Female:For Rooming Purposes Only

Title:e.g., Professor, Dr., Mr., Mrs., Ms.)

Resident of:

Citizen of:

Country Mailing Address:

Telephone:(include country code)

Fax:(include country code)

e-mail:

Educational background (undergraduate, graduate and/or post doctoral, year degrees earned):

Employment background (include dates):

Relevant research and other experience:

Reason for wishing to attend this NATO ASI:

Any other relevant information:

"For those who wish to apply for a grant covering living expenses and possible partial travel support, a statement of reference must be received from your research advisor or supervisor. This may be sent via e-mail or fax. These grants will be awarded mainly to graduate students and post-doctoral research associates from NATO countries and some Eastern European countries: Bulgaria, the Czech and Slovak Republics, Hungary, Poland, Romania and those countries that have comprised the former USSR." "Do you wish to apply for partial support (yes/no):

For those requesting NATO financial support, please indicate support desired: Full room & board for 12 days (yes/no):

Partial travel support (yes/no):

NOTE: SUPPORTED PARTICIPANTS MUST SHARE A DOUBLE ROOM; TRAVEL SUPPORT LIMITED TO $200 FOR EUROPEANS AND $300 FOR NORTH AMERICANS, BUT WILL BE RARE DUE TO LIMITED AVAILABILITY OF FUNDS. ALL ACCEPTED APPLICANTS MUST ENSURE THEIR PARTICIPATION IN ADVANCE WITH A NON-REFUNDABLE DEPOSIT OF $200 OR ITS EQUIVALENT IN FRENCH FRANCS If a financial award is not made, I still may attend (yes/no):

APPLICATION (& SUPPORTING DOCUMENTATION, IF APPLICABLE) MUST BE RECEIVED NO LATER THAN FEBRUARY 1, 1999. APPLICANTS SHOULD BE NOTIFIED OF DECISION BY MARCH 5, 1999.

Direct correspondence (e-mail preferred):

Dr. Harold Weinstock
e-mail: [email protected]
telephone: 703-696-8572
facsimile: 703-696-8481

AFOSR/NE
801 N Randolph Street
Room 732
Arlington, VA 22203-1977 USA