FORM C

INTERNATIONAL ATOMIC ENERGY AGENCY 
F1-TC-1046.2
2nd IAEA Technical Committee Meeting on
Control, Data Acquisition and Remote Participation for Fusion Research

19 - 21 July 1999 
Centro de Fusao Nuclear, Lisbon, Portugal

To be sent to the competent official authority (Ministry of Foreign Affairs, national atomic energy 
authority) for transmission to the International Atomic Energy Agency, Vienna International Centre, Wagramer Strasse 5, P.O. Box 100, A-1400 Vienna, Austria, Telefax No. (+43-1) 26007
	
	GRANT FORM *

Name:	(Mr./Ms.):

Mailing Address:
	Telex:
	Telefax:
	Telephone:
	E-Mail:

Date of Birth (year/month/day):	Nationality:

1. EDUCATION (Post-Secondary)
Name and Place of Institution	Field of Study	Diploma or Degree	Years Attended		
			from	to	

					

2. RECENT EMPLOYMENT RECORD (Starting with your present post)
Name and Place of Employer/organization	Title of your position	Type of Work	Years Attended		
			from	to	

					
					
3. DESCRIPTION OF WORK (Performed over the last three years)

4. INSTITUTE'S/MEMBER STATE'S PROGRAMME IN THE FIELD OF MEETING

Date	                    Signature of applicant

Date	Name and title (printed) and signature of responsible Government official

*  To be completed only by participants from developing countries on whose behalf a grant is requested.