ࡱ>   &bjbj33 ~Q_Q_ $$$$$4;$;$;$h$/%$;$%K~S&Z''''(((JJJJJJJ$OYRBJ$(((((J$$''HJ+++($'$'J+(J++RtEG Q2i )hFJJ0%KFbR)R<GGxR$`H0((+(((((JJ+(((%K((((R((((((((( ": Annex I The Second WESTPAC Workshop on Distribution, Source, Fate and Impacts of Marine Microplastics in Asia and the Pacific 15-17 October 2018, East China Normal University, Shanghai, China REGISTRATION FORM Title FORMCHECKBOX  Mr /  FORMCHECKBOX  Ms First name Family nameGender FORMCHECKBOX  Male  FORMCHECKBOX  FemaleNationalityDate of birthEducation level FORMCHECKBOX  Bachelor  FORMCHECKBOX  Master  FORMCHECKBOX  PhD Graduated from: Major: Supervisor/Advisor: Job titleAffiliationYears of experience in current jobAddressTel. number(s)Fax number(s)Email(s)Contact person, in case of emergencyDietary Restriction FORMCHECKBOX  None  FORMCHECKBOX  No pork  FORMCHECKBOX  No beef  FORMCHECKBOX  Other, please specify Major and/or Research AreaPrevious Workshops attended and related to this workshop FORMCHECKBOX  No  FORMCHECKBOX  Yes, please specify the workshop titles: (a) (b) Brief statement of research activities/work experience that is linked to this workshop, and related publication if any (This part is crucial for qualifying, so separate pages could be annexed to this form) Please provide name and E-mail address of two referees whom can be contacted to support your applicationReferee #1NameJob titleAffiliationEmailTelReferee #2NameJob titleAffiliationEmailTelAs to the Microplastic research symposium on 15 October 2018, I would like to make a presentation on_____________________; Financial assistance  FORMCHECKBOX  I could cover my expense.  FORMCHECKBOX  I would apply for the financial assistance on local hotel.  FORMCHECKBOX  I would apply for the financial assistance on round trip airfare and local hotel. Date: . 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