ࡱ > i _ bjbjzz \\ _ * * 8 | <0 L . H T / / / / / / / $ 2 4 l / \ " \ \ / : / \ R / \ / - | / `G⛒ R . / 0 0 <0 -. @6 @6 $ / @6 / \ \ \ \ \ \ \ / / \ \ \ <0 \ \ \ \ @6 \ \ \ \ \ \ \ \ \ * > h : Request Form Ajaib (Jab) and Nirmal (Munni) Sidhoo Charities Fund Trainee Travel Grants for International Scientific Conferences Name: Academic Department/Division: Program: ____Masters ____PhD ____Post-doc Fellow ____ Research FellowProgram Year (e.g. 1st of 3): Name of Supervisor: Academic Department/Division: Location of Research ActivitySite: _____ VGH _____ UBCHName of VCH Research Centre/Program that the supervisor has their primary affiliation with: Name of Conference: Conference Date and Location: Presentation Type: _____ Poster _____ Oral _____ Panel _____ Workshop _____ Other (list): ______________________________________________SignaturesTrainee Name: Supervisor Name:Trainee Signature: Supervisor Signature:Date: Date:Trainee Contact InformationMailing Address (Work): Email: Telephone Numbers: (Office) (Laboratory) (Fax)Supervisor Contact InformationMailing Address (Work): Email:Telephone Numbers: (Office) (Laboratory) (Fax)How does the research being presented fit within the guidelines of this fund? Is this the first time that you or anyone else is presenting this data/information at an international conference? Is this project your own project, whether stand-alone or as part of a larger study? If no above, please briefly describe your role in the specific project being presented: Please ensure the following 2 items are attached and submitted with the request form: complete abstract submitted to the conference, including presentation title and authors proof of acceptance to the conference (eg. letter of acceptance or copy of program/agenda with their name listed) Page PAGE 2 of NUMPAGES 2 Page PAGE 1 of NUMPAGES 2 B C 3 5 X [ x z . 0 B C D I K b q v x } ( ) - . 0 7 8 @ B C D E Ҽɼɼɼɼɼɼɼɼɼɳɭɳɭɳɭɼ h>_ CJ hA{ CJ hK hA{ CJ hK CJ hK 5CJ hK hK CJ hK hK 5CJ hWh hK ^J aJ hK h.;; hK hA{ hK ; h`, ; A C ~ I kd $$If 0 :`' : & `' a yt>_ ( $If gdK Z ( $If ^Z gdA{ ( $If ]gdK gdK $ a$gdA{ 3 4 5 X Y Z y Z ( $If ^Z gdA{ 6 kd $$If A `' `' `' a ytK ( $If gdK 6 kd_ $$If `' `' `' a ytK Z [ y z C 8 ( $If gdK c kd| $$If l | `' `' 0 `' 4 l a ytK ( $If ^gdK I kd $$If 0 :`' : & `' a ytK . / } } G } } 6 kd $$If i `' `' `' a ytK ( $If gdK v kd $$If l 0 `' 0 `' 4 l a ytK / 0 y ( $If gdK 6 kdD $$If % `' `' `' a yt>_ b ( $If gdK 6 kd $$If `' `' `' a ytA{ / 0 C D E F V I kd $$If 0 `' `' a ytA{ Z ( $If ^Z gdA{ ( $If gdK E kd $$If X `'`' `' a p yt>_ E F P Q Z [ a b h i k t { | - K M h k E N ˸߲߲ߪ hA{ h\ h7h h4$ j h4$ U hP