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APPLICATION FORM

10th International Women & Health Meeting

September 21 – 25, 2005, New Delhi, India

Around 600-700 people are expected to participate in the 10th IWHM in India. To ensure representative participation, quotas will have to be fixed for different countries/region of the world. Filling out this form therefore does not guarantee registration to the 10th IWHM.

    Section I

    1. Name (as in Passport) *

    2. Sex*

    3. Age*

    4. Title/ Profession *

    5. Organization *

    6. Mailing Address *

    Telehone Number *

    Fax No.

    Email *

    7.
    Language Preference: *

    8. Accompanying Person
    (applies only to applicants with disability)

    Accompanying children:

    1.

    2.

    Crèche facility for children below 12 yrs will be provided free of cost. Other costs such as food will be charged separately. Please contact Secretariat for further details.

    9. Are you submitting a write-up/ proposal, workshop etc. for presentation? *

    (Please skip Section II)

    10. Do you wish to apply for scholarship/subsidies to support your participation? *

    (Please skip Section III)

    Section II

    Submission of write-ups/ descriptions for paper presentation/
    cultural events/ workshops

    The deadline for submission is January 31st 2005. Participants will be informed about the acceptance of their proposal by March 30th 2005.

    1. Which of the following programs do you wish to submit a write up for?

    2. Title of presentation/ workshop

    3. Name of the Author(s), Organizer (s) (Individual/ Organization)

    4. Write-up (should not exceed 300 words)

    Guidelines for Submissions

    1. The write-up must clearly address the IWHM theme and objectives and should contribute to action and/or conceptual clarity.

    2. It should focus on the work done in the last three years.

    3. It should not have been presented in previous International Conferences or Meetings.

    4. The write up should include a statement on each of the following:

    • Objectives and main focus of the paper/workshop/ symposia/cultural event
    • Strategies/methods used
    • Results/ lessons learned
    • Conclusion, including policy implications, if any

    Section III

    Application for Scholarships/ Subsidies

    Participants whose proposals have been accepted and who have made a request for subsidies, would be eligible to receive scholarships, provided we have enough funds to do so. A small number of subsidies will also be made available to participants representing local, regional and global non-funded networks or groups even if they are not submitting a proposal at this stage. Applicants will be informed if they have been selected to receive a scholarship by 31st May 2005. The total number of scholarships available is limited. All applicants are therefore advised to seek funding from other sources, even if their abstracts /proposals are accepted for presentation.

    Applicant's Information

    1. Name (as in Passport)

    4. Organization
    Position in the Organization:

    Questionnaire

    5. Have you sought/are seeking funding from other sources? If yes, Give details.

    6. Are you part of any Network/Organization involved in women's health? Give details of your organization's work and your individual role in it.

    7. Describe the work that you do in the field of women's health.

    8. To enable utmost diversity and greater representation of 'marginalized' groups, you are requested to complete the following section:

    8.1 Do you belong to any of the following groups? Please provide details, if possible.

    8.2
    Indicate special requirements if any:

    9. State the different ways you will share the knowledge acquired during the IWHM on your return to your home country/community.

    10. Give reasons for seeking a Scholarship.

    11. SCHOLARSHIP OPTIONS: Not all your expenses to attend the meeting may necessarily be paid. In some cases, however, full financial support may be considered.

    Please indicate the support you actually need: (click the checkbox for an item you want to choose).

    Please indicate if you need a visa to enter India, If so, please obtain a visa application and be prepared to submit it if you receive a scholarship.

    Financial assistance will not be provided to delegates who arrive at the meeting without a confirmed scholarship award.

    All Cancellations/Alterations must be made in writing and sent to the 10th IWHM Secretariat. All refunds will be processed after the event.

    PAYMENT

    Payment should be made in US $ or Indian Rupees payable to "10th International Women & Health Meeting" only on receiving a confirmation from the Secretariat. The payment should be made through a Banker's draft. Personal or organization cheque will not be accepted.

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