APPLICATION FORM

CCP5 METHODS IN MOLECULAR
SIMULATION SUMMER SCHOOL 2011

Queen's University Belfast
Belfast
Northern Ireland

17th-26th July 2011

Please complete the form and press the SUBMIT button below.
All the fields in boldface are required, but please fill in the others if applicable.
Selection for the Summer School will be based on the strength of information provided on this form.
Summer School students will be selected during the week commencing 21st March 2011.

Personal Information

TITLE:
SURNAME:
FIRST NAME(S):
MALE/FEMALE:
NATIONALITY:

Department:
University or Institute
ADDRESS:
CITY:		COUNTY/STATE:
POSTCODE:		COUNTRY:
TEL:		FAX:
EMAIL:

QUALIFICATIONS:

Please state your academic qualifications (please give subjects):

RESEARCH:

Please specify the nature of your research and the role of molecular simulation (Max 500 words):

SUPERVISOR:

Please provide the name and e-mail address of your supervisor:

NAME:
EMAIL:

PROGRAMMING LANGUAGES:

Please state the languages you are familiar with:

FORTRAN 77

FORTRAN 90

Others (say which):

POSTER PRESENTATION:

Please state if you intend to present a poster:
I will be presenting a poster
Title of poster:
Poster abstract:

STUDENT SEMINAR:

Please state if you wish to present a 10 minute seminar on your research:
I wish to present a seminar
Seminar Title:
Seminar abstract:

ADDITIONAL INFORMATION:

Please enter any important additional information, such as physical handicap or dietary requirements here.

Information:

Thank you for filling out this form. Please click on the SUBMIT button to complete registration.

Please send any queries to : john.purton@stfc.ac.uk

J. Purton