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T3 Application Form

(Please use this as a template for providing all requested data in whatever detail necessary)

Applicant's Name:

Mailing Address:

Telephone Number(s):

Fax Number(s):

E-mail Address(s):

Please indicate which Workshop you are applying for:

August 7, 8 & 9, 2004 at UCLA ____
January 8, 9 & 10, 2005 at Duke University____
If you are potentially able to attend either workshop please indicate here _____

Please attach an electronic copy of your resume.

If you wish to apply to the NCC for a Travel Grant, please estimate the amount of travel support you will need. Travel funds from the NCC will be limited and applicants should also seek support from their home institution.

Seminar trainees will be housed in double-occupancy facilities. To assist the NCC in planning for room assignments please note your gender, smoking habits, and any characteristics that might aid in room assignments.