WALLS AND BRIDGES | APPLICATION FORM
Thank you for your interest in this program. To assist in arranging a successful tour, please supply the
information
requested
below
and
return
this
form
to
Anne-Sophie
Hermil
annesophie.hermil@diplomatie.gouv.fr AND Mathilde Billaud at m.billaud@villagillet.net.
Please note that the welcoming institution is expected to take care of housing cost and honorarium for the
speaker. The Villa Gillet will pay for international airfares but domestic flights, trains and buses to and from
New York are to be paid and arranged by the welcoming institution.
AUTHOR’S NAME:
HOSTING INSTITUTION
CONTACT INFORMATION OF THE PERSON IN CHARGE OF THE AUTHOR’S VISIT:
Name and title
Phone
Cellular
Fax
Email
PREFERED DATE AND TIIME
Please pick 2 or 3 dates that would be convenient for you (during the tour):
1st choice:
2nd choice:
3rd choice:
Preferred time for the event:
FORMAT OF THE EVENT
Length:
Language:
French
English
If the author is unable to give his speech in English, will you provide an interpreter?
Topic:
PLEASE CHECK ONE OR MORE OF THE FOLLOWINGS:
Lecture / Seminar / Workshop / Luncheon / Reading / Q&A
Meeting with the students and/or faculty
Other:
Yes
No
PRACTICAL INFORMATION
HOSTING INSTITUTION ADDRESS
CLOSEST AIRPORTS:
Airport 1:
Airport 2:
Time needed to get from Airport 1 to your institution:
Time needed to get from Airport 2 to your institution:
OR CLOSEST TRAIN / BUS STATION:
Train or bus station name:
Time needed to get from train or bus station to your institution:
Honorarium offered:
Number of hotel nights your institution can pay for:
ADDRESS OF THE HOTEL WHERE YOU WILL HOST THE AUTHOR:
OTHER RELEVANT INFORMATION:
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