APPLICATION FOR TRAVEL GRANT
NEW ZEALAND INSTITUTE OF CHEMISTRY (NZIC) CANTERBURY BRANCH
Name
Contact address
Phone no
NZIC member since
Institution
Department
Supervisor(s)
Postgraduate study
Masters
PhD
Other (specify)
(identify appropriate)
Name of intended conference or meeting
Location and date of conference/meeting
Type of presentation (identify appropriate)
Oral
Poster
Presentation Title
Summary of overall costs
Summary of Other Funding
Brief personal details (including how attendance is contributing to furthering your scientific pursuits)
Supporting person/referee (should clarification be required. Please include phone number)
Details of any previous awards received from the NZIC Canterbury Branch
Applicant’s signature
I agree to comply with the conditions of the NZIC award and any others that may be
identified.
Signature
Date