2014 Fact Sheet

 
1. Last Name
2. First Name
3. E-mail address
4. Country of Current Residence
5. Application Category
6. Section (please, select one if applicable)
7. Attendance (Have you attended the Convention before?)
8. Work/Student Title (for example: Assistant Professor, PhD Student, etc.)
9. Academic Discipline
10. Keyword related to your proposal
11. Second keyword related to your proposal
12. Third keyword related to your proposal
13. Affiliation (University/Organization/Independent Researcher)
14. Phone Number
15. Paper or Film Title (if applicable)
16. Panel Title (if submitting as a part of a panel)
17. Audio-Visual Request (if applicable)
(Please, note that in order to use a projector, you have to bring your own laptop)
18. If your application is accepted, will you require a printed invitation (for visa/reimbursement)?
19. Do you require a visa?
20. Preferred Postal Address (please, specify the Country)
21. If applicable, please indicate your most recent book and/or dissertation (in the original language of publication, with an English translation, with the YEAR, the city of publication and the NAME OF PUBLISHER or YEAR of defense and UNIVERSITY)
22. If you are a PhD student, please indicate the provisional title of your dissertation (in the language in which it is to be written) and expected year of defense (a month is necessary for a 2013 defense).
Powered by SurveyMonkey
Check out our sample surveys and create your own now!