PUBLIC HEALTH AND GLOBAL GOVERNANCE OF ALCOHOLTHEMATIC MEETING 2019

APPLICATION FORM FOR TRAVEL SUPPORT to attend and present a paper at the conference on Public Health and the Global Governance of Alcohol, 30 September – 3 October 2019 in Melbourne, Australia. This form is to be submitted by 1 April 2019.

We have limited funding to provide some travel support to a small number of applicants. Decisions on support will be made by 1 May 2019. Decisions will include consideration of the strength of the abstract, its relevance to the conference themes, and the breadth of geographic and disciplinary representation at the conference.

Please complete the form below.

Name: ___________________________________________________________________

Nationality:_______________________________________________________________

Address:__________________________________________________________________

Telephone:_______________________________________________________________________

Email: __________________________________________________________________________

Closest international airport to the address from which you would travel to the conference:______________________________________________________________________ Highest academic or professional degree: _______________________________________

Subject/Discipline:__________________________________________________________

Current employer and position:________________________________________________

__________________________________________________________________________

Title of abstract submitted:___________________________________________________

______________________________(Note: to be considered for support, the abstract must be submitted by 1 April 2019)

Will you be able to provide a full paper to the conference website by 15 September 2019?

⃝ Yes ⃝ No

Any activities relevant to the conference’s themes:_________________________________

___________________________________________________________________________

___________________________________________________________________________

What level of financial support are you seeking? __________________________________

_________________________________________________________________________________

Reasons support is requested: __________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Budget: (AUD $1 is about 0.70 US dollars)(Hotel accommodation in Melbourne is likely to be at least AUD $150 per night; transport costs by bus from/to Melbourne airport will total AUD $40)

Detailed budget (List all items individually) AUD$ amount

Economy Airfare

Accommodation (including breakfast) (amount per night x number of nights)

Land transportation costs (bus, taxi, train)

Other costs (please itemise below)

Total