Please use this application form to submit your proposal for the Science Festival 2017
Name*: The last name of the person responsible is mandatory !
First name*: The first name of the person responsible is mandatory !
Institution/Company* (1): The name of the institution/company is mandatory !
(1) if you are applying on behalf of an institution (research centre, company, association, school, etc) the Administrative Head of the institution must have expressed his/her consent beforehand and he/she will have to co-sign the contract if your proposal is selected.
Administrative Head and his fonction (for example Paul Schmit, director) :
Adress for correspondence* (2): please select home address address of institution/company The kind of correspondence is mandatory !
(2) if you are applying on behalf of an institution, please indicate the institution's address. If you are applying as a private person, please indicate your personal address.
Street: The address is mandatory !
Postcode*: without country indicator! The postal code is mandatory !
City*: The city is mandatory !
Country*: please select Luxembourg Germany France Belgium The Netherlands Switzerland Austria Great Britain Other Italy Iceland The country is mandatory !
E-Mail*: The e-mail address is mandatory !This is not a valid e-mail address! Phone (work)*: The work phone number is mandatory ! Phone (home): Phone (mobile):
Website : without http:// Yes, we would like to have a link from www.science-festival.lu to our website
(Please complete a separate form for each proposed activity)
Title of proposed activity* (Please try to think of a catchy title!) The title of the activity is mandatory !
Please explain concisely what your activity is all about and how you will meet the selection criteria.*
The description of the activity is mandatory !
Please tick the appropriate boxes : During the week, for school classes :
We propose the activity
Material budget (new/hired) : Euro Detail :
Transport budget : Euro Detail :
Animation budget: We need a financial contribution for the animation:* please select yes no You need to indicate whether or not you need a financial contribution for the animation! The flatrate for preparing/running the activity per animator present during the 4 whole days is 600 Euro (or 300 Euro for 2 whole days). Example of calculation: Tom runs the workshop on Thursday and Pierre on Friday. This amounts to eligible costs of 300 Euro for the animation budget for the 2 days of the week (1 animator x 300 Euro). Animators present during the week : only numbers! Animators present during the weekend : only numbers! Total Budget animation : Euro Remarque :
Accommodation budget : Euro (The maximum eligible amount per person per night is EUR 125, including all taxes) Detail :
Total estimated budget required : Euro
Bank details : Name of bank*: The name of the bank is mandatory !
IBAN account number*: The account number is mandatory !
BIC code (for foreign banks): The BIC code is mandatory !
Account holder*:The name of the account holder is mandatory !
Do you need additional staff? If so, how many? during the week (A) only numbers! during the weekend (B) only numbers! Note: During the selection and the comparing of the proposals, we will adjust your budget by adding 'A' x EUR 300 + 'B' x EUR 300. Even though you won't receive this amount personally, we still have to pay this staff separately for your activity. These costs are therefore an integral part of your estimated budget.
The standard space of your site is 5x5 m; if that is not suitable, please indicate the space required:
Comments :
