Updated: Oct 13, 2010

Student Sponsorship Form

Dear SEISMIX 2010 Organising Committee

I wish to apply for student registration for SEISMIX 2010, acknowledging that IGCP559 is supporting my attendance.

Student Name: ______________________________________________________________________

School or Facility: ____________________________________________________________________

University: _________________________________________________________________________

Email: _____________________________________________________________________________

Phone number: ______________________________________________________________________

Course being undertaken: _____________________________________________________________

Interest in 14th International Symposium on “Deep Seismic Probing of the Continents and their Margins”:

__________________________________________________________________________________

Students Signature:__________________________________________________________________

Supervisions Name: __________________________________________________________________

Supervisions E:mail: __________________________________________________________________

Supervisors Signature: ________________________________________________________________

recommending support attending: _______________________________________________________

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