Science Visitor Application Form

Submit this form to apply for a funded science visit to an ICRAR node.

Your Details

Title

First Name *

Last Name *

Your Email *

Preferred contact number in Perth *

Home institution / company *

Home institution / company Address

Apt, suite, etc.

Country

City

State

Zip code

Visit Details

ICRAR Nominator's Name *

ICRAR Nominator's Email *

ICRAR Nodes *

Which ICRAR nodes do you intend to visit?

ICRAR-Curtin

ICRAR-UWA

Approx date of arrival *

Type in a date in format dd/mm/yyyy

Approx date of departure *

Type in a date in format dd/mm/yyyy

Purpose of Visit *

Up to 500 words

Research Seminar *

Yes

ICRAR encourages visitors to present their work at one or both ICRAR nodes while in Perth; would you be willing to do so?

If yes, which node/s?

ICRAR-Curtin

ICRAR-UWA

Visit Requirements

Travel and accommodation funds requested *

Travel bookings *

Yes

Do you require assistance in making travel bookings?

Acommodation Booking *

Yes

Do you require assistance in making accommodation bookings?

Any additional information you wish to provide?

Policies

ICRAR Science Visitor Policy | Curtin University Code of Conduct | UWA Code of Conduct & Code of Ethics

Confirmation *

Yes

I have read the relevant code of conduct and science visitor policies.

Personal Information *

I consent to the above personal information being collected.

ICRAR is collecting the information in this form for the purposes of your visit only. Your information will not be shared with third parties without your permission. You can read more about how we deal with personal information in our Privacy Policy. You can unsubscribe at any time by contacting us.

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