ࡱ> KML R0bjbjVV66<<[ X\ \ 8D34gg($j!A]ATv0}HNNYL0B"B"B"PAA_XB"\ i:  Travel Award Application Form for0 Neuroscience2011Please attach your recent photographNo hand-written applications will be accepted. Applicant s contact information Name: (First name / Given name) (Middle initial) (Last name / Family name) Degree(s): Department: Institution: Address: City: Country: ZIP/Postal Code: Tel.: Fax: E-mail: Date (Month/Day/Year): Applicants signature: Your supervisor or department head Name: (First name / Given name) (Middle initial) (Last name / Family name) Degree(s): Department: Institution: Address: 00 City: Country: ZIP/Postal Code: Tel.: Fax: E-mail: Date (Month/Day/Year): Supervisor s signature: Please ensure that your supervisor sends a separate letter of recommendation (no more than one page in length) directly to Convention Secretariat (staff@neuroscience2011.jp) by no later than Feb 28, 2011 Your Referee Name: _____________________ ____________ ______________________ (First name / Given name) (Middle initial) (Last name / Family name) Degree(s): _____________________ Department:_____________________ Institution:_____________________ Address:_______________________________________________________________ _______________________________________________________________ City: _____________________ Country: _____________________ ZIP/Postal Code: _____________________ Tel.: ________________ Fax: ________________ E-mail: _________________________ Date (Month/Day/Year): _________________________ Referees signature: Please ensure that the referee sends a separate letter of recommendation (no more than one page in length) directly to Convention Secretariat (staff@neuroscience2011.jp) by no later than Feb 28, 2011 Participation at Neuroscience2011 meeting Abstract Submission Number: (Application without the abstract submission number will not be considered.) Presentation of paper at the Neuroscience2011 meeting % Prefer poster % Prefer oral presenta<hj   V X b d t v   ' * + 6 7 : ; G H K L T U ] ^ ̻||||l|l|l|heG/>*B*CJOJQJph!heG/>*B*CJOJQJo(phheG/B*CJOJQJo(phheG/B*CJOJQJphheG/5B*CJOJQJph!heG/5B*CJOJQJo(phheG/6B*OJQJphheG/6B*phheG/KHOJQJ heG/o(heG/heG/5CJo(*>Hj  V YTOO$a$$a$|kd$$IfTc0 "X0o"64 caytT $$7$8$H$Ifa$ $$Ifa$ $$If`a$` V X  + ; L ] f p }   1 h^hX`XX`X h^h`h^h `^``^ e f l o p y | }     " # ( ) 0 1 neheG/5OJQJ"heG/B*CJKHOJQJo(ph!heG/>*B*OJQJaJo(phheG/B*OJQJaJphheG/B*OJQJaJo(phheG/5>*aJo( heG/5aJheG/B*CJOJQJo(phheG/B*CJOJQJphheG/>*B*CJOJQJph!heG/>*B*CJOJQJo(ph'1 5 6 7 B O R S j   & ( : @ B d j l x  heG/B*OJQJph heG/5>*heG/5>*o( heG/5heG/56>*B*ph heG/>*o( heG/o(heG/heG/>*B*CJOJQJph!heG/>*B*CJOJQJo(phheG/B*CJOJQJphheG/B*CJOJQJo(ph1  ( B l ( * apq .Ps `^``h^hX`X h^h`h^h  & ( * P X %(A`abgpvw 9:̦̘̾z heG/5 heG/o(heG/heG/B*CJOJQJo(phheG/B*CJOJQJphheG/5OJQJheG/6B*OJQJo(phheG/6B*OJQJphheG/5CJOJQJheG/B*OJQJphheG/>*B*OJQJo(phheG/5B*OJQJph*s:bz#$.< ( d @d hdWDU`dh^hX`XX`X(^( h^h`"#$.ffǶuhYH*CJOJPJQJaJo(heG/>*CJOJPJQJaJheG/CJOJQJaJo(heG/5CJOJQJ\aJo(heG/5CJOJQJ\aJ heG/o(heG/6B*OJQJo(phheG/6B*OJQJph heG/6B*OJQJ]o(phheG/6B*OJQJ]phheG/5B*CJOJQJphheG/B*OJQJphheG/>*B*OJQJph(((((((((((.)J)P)\)))))***:*r*t*v*x****+湪כ}sh^hh06B*phh06B*o(phheG/6B*phheG/5CJOJQJo( heG/>*CJOJPJQJaJo(heG/>*CJOJPJQJaJheG/CJOJPJQJaJo(heG/CJOJPJQJaJUheG/CJOJPJQJaJheG/CJOJPJQJaJo(heG/CJOJQJaJheG/CJOJQJaJo($tion (All applicants must prepare the presentation of poster for an advance meeting.) JNSS membership % JNSS ID number: (if you have) % will apply (if you do not have yet) Have you previously been award JNSS Travel Award? % No % Yes (Month, Year: ) Please send the completed application form with the photograph and hand-written signatures, your CV, your publication list, and a copy of your passport (only the page where the photograph of your (((L)))v*x*000000000000000$a$$4$a$ 8!G$ @d d dWDU` d+,+>+@+l++,0000 0+0-0F0G0h0p0u00000000000000000000000000¨¨᠜zoh85mHnHu h3QO5jh3QO5UaJh3QOmHsH h3QOo(h3QOh;jh;Uh06B*OJQJo(phh06B*o(phheG/6B*OJQJo(phheG/6B*OJQJphUheG/6B*o(phheG/6B*phh06B*ph+face is recorded) to Convention Secretariat (staff@neuroscience2011.jp) by e-mail attachment all as pdf or jpeg files no later than March 4, 2011.     Neuroscience2011 Travel Award Application Form PAGE1 / NUMPAGES2 00000000000heG/6B*o(phh;h3QOOJQJo(h3QOh85mHnHu h3QO5jh3QO5UaJ 000 8!G$4&P 1. 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