Travel Grant Programme 2015

APPLICATION FORM

 

Support for Young Members’ participation in International Committee Meetings in 2015

 

 

DEADLINE TO SUBMIT THE COMPLETED APPLICATION:

15 December, 2014 at midnight (Paris time)

 

PLEASE RETURN THE COMPLETED FORM

BY EMAIL TO:

grants@icom.museum and specify imperatively in the email subject: Ref Young Members

 

BY POST TO:

Béatrice ECOSSE

International Council of Museums (ICOM)

UNESCO House

1, rue Miollis

75015 Paris, France

Telephone: + 33 (0) 1 47 34 91 66

Fax: + 33 (0) 1 43 06 78 62

 

Applicant’s personal details
Surname(s)  
First name(s)  
Date of birth

(Please include a copy of your passport)

  
Individual ICOM Membership number  
ICOM member since  
Member of the following International Committee(s)

since

  
Institution  
Position in your Institution  
Professional Address
 
City                                                      Postal code                               Country
 
Telephone number  
E-mail  

About the Meeting
International Committee Meeting you wish to attend in 2015

(A list of these meetings is available at http://icom.museum/events/calendar/2015/ and http://icommunity.icom.museum/ or check the website of the relevant International Committee directly)
 
Dates

(dd/mm/yyyy)

 From:                                            To:
Venue

(City/Country)

  

 

 

Estimated participation costs (All costs must be indicated in Euros)
Travel Itinerary
 (Economy Class)		 From:                                            To:

 

 
Travel costs

 		 
Accommodation costs

 		 
Total amount

(In Euros)

  

 

 

Submission date

(dd/mm/yyyy)

  

 

 

Applicant’s Signature   Committee Chair’s Signature 
 

 

 

  

 

Name of the Committee and the Committee Chair:

 

 

 

 

 

Incomplete Application Forms will not be processed