KIPAC Visitor Request Form

Please help us in organizing a vibrant KIPAC visitor and speaker program by completing this form if any of these apply --

The form will be reviewed by the KIPAC intellectual Life Committee and a KIPAC member will contact you.

Visitor/Speaker Full Name: *

Email address: *

Institution *

Job Title

Postdoc

Graduate Student

other

Describe your request: *

If other, please explain:

Web page

Tell us more about your interest in visiting KIPAC -- e.g., research interests, potential collaborations, other interactions?

Are you or the visitor interested in giving one of these types of talks?:

If other, please explain:

Please list a contact at KIPAC (required if requesting to give a talk):

What topics do you or the visitor primarily work on?:

Start date of the visit (If uncertain, please give approximate dates): *

Month

Day

Year

Departure date:

Month

Day

Year

Approximate Length of Stay

Note:

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