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Fax: +44 (0) 1223 423623, Tel: +44 (0) 1223 432380/2254, email:  HYPERLINK "mailto:events@rsc.org" events@rsc.orgCONFERENCE / MEETING DETAILSConference TitleDates of conference/ / to/ /APPLICANT DETAILS (please complete all fields)Title Mr  SHAPE \* MERGEFORMAT  Mrs  SHAPE \* MERGEFORMAT  Miss  SHAPE \* MERGEFORMAT  Ms  SHAPE \* MERGEFORMAT  Dr  SHAPE \* MERGEFORMAT  First NameSurnameŷAV Membership NumberPlace of Study/WorkAddressPostcodeTel / FaxEmailFIRST DEGREE DETAILSDate of completion/expected date of completion: RESEARCH SUPERVISOR DETAILS (if applicable)Title Mr  SHAPE \* MERGEFORMAT  Mrs  SHAPE \* MERGEFORMAT  Miss  SHAPE \* MERGEFORMAT  Ms  SHAPE \* MERGEFORMAT  Dr  SHAPE \* MERGEFORMAT  Professor  SHAPE \* MERGEFORMAT First NameSurnamePAYMENT DETAILS (Payment will be made by bank transfer)Name of account holder:Bank Name:Bank Address: Sort code: Account number:Overseas payments: BIC No.: IBAN No:ABA/Routing No: Currency of account:SignatureDate Bursaries are available to student and recent graduate members of the ŷAV, who do not have support available from their employer or a research grant, to attend major ŷAV Conferences Applicants should be ŷAV members at the time of application and at the time of registering for the meeting for which the travel bursary is being given The bursary award is 150 per applicant per conference and funding is supplied from the ŷAV Travel Grant Scheme Additional funds may also be available for specific conferences. 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