Dear prospective visitor:

Please fill out the following brief questioner in order that we can best process your request. For administrative purposes, we have 3 classes of visitors: seminar/colloquium, "short term", and "long term".

Seminar/Colloquium visits are for those invited to speak at either one of our regular forums or for special seminars. Such visits are usually for a day or two and we typically cover travel expenses (sharing economy class airfare among institutions to the extent possible) and up to two nights lodging.

We encourage longer visits which typically involve collaborative activities with a number of center members. Financial support will be negotiated on a case-by-case basis. Those we call "short term" range from 3 days to 2 weeks. "Long term" visits are anything over 2 weeks; these require special university approval and thus take a longer time for approval.

Thank you,
KICP Visitors & Symposia Committee

Last Name (required)
First Name (required)
Middle Initial
Institution (required)
Complete Mailing Address
E-mail (required)
Phone number
Fax number
URL of Personal Web Page (if any)
Visit Details:
Type of Visit		seminar/colloquium short term long term
Seminar/Colloquium If you are a seminar/colloquium speaker, please, fill 'Talk Date', 'Talk Title', and 'Talk Abstract' fields:
Talk Date (required only for seminar/colloquium)		MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day12345678910111213141516171819202122232425262728293031 Year200820092010
Talk Title (required only for seminar/colloquium)
Talk Abstract (seminar/colloquium)
For Short/Long Term Visit, please, fill 'Purpose of visit' field:
Purpose of visit (short/long term): please list those institute members with whom you would most likely interact
Proposed Arrival Date (required)		MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day12345678910111213141516171819202122232425262728293031 Year200820092010
Proposed Departure Date (required)		MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day12345678910111213141516171819202122232425262728293031 Year200820092010
KICP host (required)		Maximo Ave Maria Beltran Patrick 'Jojo' Boyle John E. Carlstrom Lorenzo Cazon Clarence Chang Hsiao-Wen Chen Juan I. Collar Thomas Crawford James W. Cronin Thomas Culverhouse Simon DeDeo Scott Dodelson Pedro Facal Joshua A. Frieman Evalyn I. Gates Michael D. Gladders Nickolay Y. Gnedin Geza Gyuk Elizabeth Hays Wayne Hu Brian (Thomas) Humensky Daniel Kapner Ben Koester Edward W. Kolb Andrey V. Kravtsov Akito Kusaka Randall H. Landsberg Daniel P. Marrone Jeff McMahon Stephan S. Meyer Gajus Miknaitis Brian C. Odom Angela V. Olinto Vasiliki Pavlidou Paolo Privitera Clem Pryke Luis Reyes Brant E. Robertson Kathryn Schaffer Mark Subbarao Simon P. Swordy Konstantinos Tassis Chris Thom Jeremy Tinker Michael S. Turner Amol Upadhye Carlos E. M. Wagner Scott P. Wakely Robert M. Wald Sheng "Wiley" Wang Bruce D. Winstein
Are you requesting financial support?		no yes
If yes, please indicate:
Air fare (amount)
Cost share with another institution?
Hotel (number of days)
Any special needs?
Subsistence?		no yes
Security Code:
Security Code (required) Please, type the security code (see above)

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