MIPS 2004 Request Form

I hereby request a travel and registration grant from E-Next Specific Activities Budget amounting to 750 € in EU Contribution for MIPS 2004. If accepted, it will be added to the budget of my institution.

First Name: _________________________       Last Name: ______________________
E-mail: _______________________________

Male                       Female    

Requester role:  Researcher                Ph. D. Student     

Attendance justification:
Paper presentation	  (Please name the paper)
Invited presentation	  (Please name the invited presentation)
Paper Co-author	  (Please name the paper)
Program Committee	  
Other			  (Please specify)

Technical Working Group(s) (under which the travel is considered):

Please attach a short (max. 1 page) C.V. in English     

Signature of Institution representative to E-Next

Name of representative:

E-mail of representative:

Instructions:

1)	Send a filled but unsigned copy of this form to José Félix Kukielka, kukielka@it.uc3m.es .
2)	The Management Committee will respond with an approved/disapproved message.
3)	If approved, secure the required signatures, place the signed form (.doc, .pdf or scanned copy) in BSCW subdirectory http://bscw.fokus.gmd.de/bscw/bscw.cgi/0/301263 (you may need your E-Next representative for this, since it is password protected), and inform of the availability of the signed copy in BSCW to José Félix Kukielka, kukielka@it.uc3m.es  and to the appropriate WG leader(s).