Short course proposal form (Word file, 48 KB)

SETAC Europe Short CoursesA. Short Course Proposal Form September 2005Version: 3.0Page 1 of 5SETAC Europe 18th Annual Meeting, 25-29 May 2008, Warsaw, Poland Course Title (max 15 words): Lead Instructor: Course Length: Half-day (4 hour) Full-day (8 hour) Alternate (specify) For half- day courses: AM PM No preference Course Level: Introductory Intermediate Advanced Registration Cap Minimum: Maximum: Expected nr of participants Minimum: Maximum: Abstract (200 words maximum): Course Objectives: Course Outline: Course Instructors Lead instructorName:Position:Affiliation:Role in Short Course:Address:Phone number:Fax number:Email: Co-instructorName:Position:Affiliation:Role in Short Course:Address:Phone number:Fax number:Email: Co-instructorName:Position:Affiliation:Role in Short Course:Address:Phone number:Fax number:Email: Co-instructorName:Position:Affiliation:Role in Short Course:Address:Phone number:Fax number:Email: Products/Course materials: ??SETAC Europe 18th Annual Meeting, 25-29 May 2008, Warsaw, PolandShort Course Lead Instructor: ………………………………………………………...………………… Short Course Title: ……………………………………………………………………………………… Accurately describe below what your audio visual requests are:¨ Overhead/Screen¨ Flipchart¨ 35 mm Slide projector¨ Data projector¨ Projection Computer (PC / MAC) ¨ with CD ROM ¨ with USB slot ¨ with DVD player¨ Laser pointer¨ VCR¨ Audio cassette player¨ participant Bring own Laptop (PC or MAC Hook-up)¨ Additional requests-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------? Meeting SETAC Europe 18th Annual Meeting – Warsaw 2008 Short Course Title Lead Instructor Affiliation Bank Bank address 1 Bank Account Number IBAN Code Fixed Expenditures Amount (EUR) Non specified costs (max 200 euro for half day short course, 300 euro for full day short course) Saturday night Lodging (max 100 euro/instructor)? Other expenditures 1provide a short description. For reimbursements full justification of expenses must be provided (invoices etc) 1 2 3 4 5 By his/her signature, the Lead Instructor approves that SETAC Europe pays the requested short course reimbursements on the bank account indicated. Furthermore, the lead instructor also accepts all responsibilities for settling reimbursement needs of all other instructors involved with the course indicated.Date ………………….. Signature ………………….For SETAC Europe use only Date received: …………. Items Approved:……………. Approver:……………… Date: ………… Lead instructor informed: yes/no By: email/fax/letter Date: ………… Additional reimbursement request received: yes/no Date: ………… Definitive reimbursement request received: yes/no Date: ………… Amount paid: ………EUR Date: ………… ? Proof will be required when submitting definitive reimbursement request