Request to Host a Visiting Scientist

Request to Host a Visiting Scientist
Full Name of Proposer*

Title (Example: Prof, Mrs, Mr)First NameLast Name
Email Address of Proposer*
Please provide your UCT affiliated email address
Department/Division/Unit of Proposer*
Which IDM member group do you belong to?*
Name of Visiting Scientist*
Position & Affiliation of Visiting Scientist*
Indicate the Format of the Engagement*

MasterclassKeynote address at a Symposium,SeminarScientific TalkOther
Title of Masterclass/Symposium/Seminar/Scientific Talk *
Short Biosketch to use with Advertisements *
Motivation for Visit *
Suggested Date/Preferred Month*

MonthDayYear
Date
Upload Detailed Budget Here *

Cancelof
Upload Agenda/Schedule *

Cancelof
Additional Information
Should be Empty: