Application JH Lord Travel Grant Application Step 1 of 3 33% To expedite processing of your application, append copies of supporting documentation such as abstract, brief CV, letter of support from institution. Applicants should allow at least three months for processing. 1. Personal detailsTitle*MrMsDrName* First Last Postal address for institution* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone*FacsimileEmail* Gender* Male Female Date of birth (DD/MM/YYYY)* Nationality*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe2. Type of applicationApplication for (tick only one box)* Western Australian applicant for an event in Western Australia Western Australian applicant for an interstate event Western Australian applicant for an overseas event Interstate applicant for an event in Western Australia Overseas applicant for an event in Western Australia Is the event organised by Geoconferences?* Yes No Are you an overseas applicant applying from a developing country as listed on UN site?* Yes No List of developing countries can be found at the United Nations Development Programme webpage. 3. Applicant categoryApplicant category* Full-time tertiary or postgraduate student Full-time researcher from developing country who received doctorate in last 5 years 4. University qualifications and current enrolment if applying as full-time studentUndergraduatePlease specify your enrolment:* Current Completed Not applicable Institution Qualification (Expected) graduation date (MM/YYYY) Other postgraduatePlease specify your enrolment:* Current Completed Not applicable Institution Qualification Brief description of coursework or research(Expected) graduation date (MM/YYYY) DoctoratePlease specify your enrolment:* Current Completed Not applicable Institution Qualification Thesis title Supervisor/s (Expected) graduation date (MM/YYYY) 5. University qualifications if applying as postdoctoral researcherCurrent postdoctoral positionInstitution Brief description of researchCommencement date (MM/YYYY) (Expected) completion date (MM/YYYY) DoctorateInstitution Qualification attained Thesis title Supervisor/s Graduation date (MM/YYYY) Other postgraduateInstitution Qualification attained Brief description of coursework or researchGraduation date (MM/YYYY) UndergraduateInstitution Qualification attained Graduation date (MM/YYYY) List all reseach positions held or employment prior to current postdoctoral positionResearchInstitution Brief description of researchCommencement date (MM/YYYY) Completion date (MM/YYYY) Other employmentEmployer Brief description of dutiesCommencement date (MM/YYYY) Completion date (MM/YYYY) 6. Event detailsPlease choose one* Conference Field excursion Title of event* Date/s* Location* Organised by* 7. Your contribution to eventAre you presenting?* Yes No If presenting, title of presentation Authorship of presentation Presentation type Oral Poster Presentation accepted Yes Waiting for response 8. How will attending this event benefit Western Australian geology?9. Other funding or logistical supportRegistrationMonetary support (currency and amount)In-kind support (describe and estimate value)Provided byActual or estimated amount (specify currency)TravelMonetary support (currency and amount)In-kind support (describe and estimate value)Provided byActual or estimated amount (specify currency)AccommodationMonetary support (currency and amount)In-kind support (describe and estimate value)Provided byActual or estimated amount (specify currency)Living expensesMonetary support (currency and amount)In-kind support (describe and estimate value)Provided byActual or estimated amount (specify currency)10. File uploadAttach copies of supporting documentation such as abstract, acceptance letter from organisers, brief CV and signed letter of support from institution.Abstract (if applicable)Accepted file types: pdf, doc, docx, pages, Max. file size: 2 MB.Acceptance letter from organisers (if applicable)Accepted file types: pdf, doc, docx, pages, Max. file size: 2 MB.CV (if applicable)Accepted file types: pdf, doc, docx, pages, Max. file size: 2 MB.Letter of support from institution*Accepted file types: pdf, doc, docx, pages, Max. file size: 2 MB.'Letter of support from institution' means a statement from the institution indicating the applicant is a student or post-doctoral research at that institutionDeclarationIf I receive a JH Lord Travel Grant, I agree to: acknowledge the support of Geoconferences during the event and prepare a short report (200-300 words) on how the travel grant was used and its benefits, and submit the report to Geoconferences within 6 weeks of the event. I agree to the terms and conditions set out by Geoconferences (WA) Inc.