Application for URSI Sponsorship

FORM 3 (loan - due for mode C)

Please fill in this form (on screen), print it, sign it and return it to the URSI Secretariat at the following address : URSI, c/o INTEC, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
If your browser cannot read forms, just contact info@ursi.org  and we will send you one.

1. Name, location and dates of the meeting :

2. Requested loan : Euro

3. Budget of the meeting :

3.1 Expenditure

3.1.1 Working costs
a) Secretariat : give breakdown of personnel and other costs :
b) Renting costs (rooms, equipment)
c) Photocopying facilities
d) Stamps
e) Telephone, telex
f) Transportation
g) Insurance

3.1.2 Travel costs : give, for each beneficiary, name, title or quality,
departure location, cost :





3.1.3 Subsistence costs : give, for each beneficiary, name,title or quality,
number of days, amount :



3.1.4 Grants paid to speakers or reporters :

3.1.5 Announcements and programme printing costs :
a) Announcements in journals
b) Call for papers
c) Programme

3.1.6 Preprints :
a) Fixed costs
b) Printing costs
Number times unit cost =

3.1.7 Simultaneous translation costs :

3.1.8 Scientific visits and tours :

3.1.9 Welcome costs :
a) Hostesses
b) Information to participants (documents, briefcase, etc.)

3.1.10 Social programme (if included in budget) :
a) Lunches or dinners offered by key speakers
b) Reception
c) Banquet

TOTAL EXPENDITURE :

3.2 Income

3.2.1 Registration
a) Normal fee times. participants :
b) Reduced fee times participants : (for advance payment)
c) Reduced fee times participants : (for young scientists and students)

3.2.2 Grants :
a) From URSI : fixed sum (mode B) : , loan (mode C) :
b) From other sponsors : give, for each of them, the name and amount, mentioning if known or expected.


3.2.3 Selling of reports :
a) Preprints : number times unit price
b) Other :
c) Copyrights :

3.2.4 Advertising
3.2.5 Registration for scientific visits :

3.2.6 Social programme (if included in budget)
a) Grants :
b) Registration for receptions :
c) Registration for banquet :
Does the fee include the banquet ?

TOTAL INCOME

3.3 Balance

3.3.1 Difference (Total 3.2 less Total 3.1) : .
(should at least be equal to URSI loan)
3.3.2 Less URSI loan :

NET PROFIT

This form was filled in by :
Name :
Fax
E-mail
Date : Signed

Please fill in this form (on screen), print it, sign it and return it to :

The URSI Secretariat
c/o Ghent University / INTEC
Sint-Pietersnieuwstraat 41
B-9000 GHENT, BELGIUM
fax (32) 9-264.42.88


 

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