Application Form for the 14th (2018) Early Career Award in Biophysics and Early Career Presentation Award

※Fill out all the information in the form,convert the file into PDF format, and upload from the online registration site of the 54th Annual Meeting of BSJ. Please adjust the two items “1. Contact address of the applicant” and “2. Presentation title, authors and research field” to fit into 1 page.Please adjustthe item “3.Abstract and related information” to fit into 2 pages. If necessary, you can add extra pages only for the rest of the items. Please be sure to adhere to all the notes described. The BSJ office will send you a receipt of the Award application by Email (Note that this is different from an Email for a receipt of a regular presentation registration). If you do not receive the Email after one week of the closure of the application period, please contact the BSJ office ().

1. Contact address of the applicant

※The BSJ controls your contact address confidentially and uses it only inthe selection process of the awards.

Name:

Affiliation:

Membership Number:

※If you are currently applying for the membership of BSJ, please write "0000". To apply for the membership, you need to register from the BSJ website and pay the annual membership fee.Please make sure to apply for the Early Career Award in Biophysicsafter completing both procedures of the membership application.

Address (mandatory):

Phone and FAX Numbers:

E-mail Address (mandatory):

2. Presentation title, authors and research field

※Please use smaller fonts in case there are many authors.

a) Title:

b) Names of presenters: Taro SEIBUTSU(1)(2), Jiro BUTSURI(1)(3)，Goro SEIKA(4)

※All authors including yourself and collaborators. The applicant must be the first author of the presentation.

c) Affiliations: (1) Graduate School of xxx, University of xxxx. (2) Institute of xxxxxxx, University of xxxx. (3) Institute of yyyyyyy, yyyyy University. (4) School of xxxxxx, zzzzz University.

d) Application for Student Presentation Award (student members only): Yes / No (delete either of them)

※If you would like to apply for the Student Presentation Award, please make sure to complete the application procedure for it as well.

e) Research field:

※Please choose one from the followinglist. If you choose “12. Others”, please specify your research fields.

1. Structure and Function of Proteins 2. Properties of Proteins3. Nucleic Acids

4. Cell Biology 5. Photobiology6. Muscle

7. Molecular Motors 8. Biomembranes, Artificial Membranes 9. Bioinformatics

10. Imaging, Methodology 11. Brain and Neuroscience 12. Others (Please specify)

3. Abstract and related information

※If necessary, you can insert figures and/or tables. Please note that the item (a) should be within 1 page and that the items (b) and (c) should be within 1 page. Please use fonts larger than 11 points in the main text. Do not change margins and spaces between lines. Please write the number of words of each item.

a) Abstract (less than 400 words) (Describe in more detail than the registered abstract for the abstract book.)

Word counts of item (a): words

b) Scientificsignificance of your presentation(less than 300 words)

Word counts of item (b): words

c) Your contribution to the work (less than 100 words)

Word counts of item (c): words

4. Information of the applicant

a)Date of birth (Year/Month/Day)

b)Date of degree obtained (or scheduled date of degree obtained) (Year/Month)

c)Profile (If you have experienced childbirth and/or nursing care, please mention them.)

【Education】(after graduation from the university)

【Work Experience】

【Other Comments】

※Please describe the periods of maternity, child-care and other leaves if you have experienced childbirth and/or nursing care. Even if the sum of these periods is less than 2 years, the following requirement of the application still applies: “he/she must be 37 years old or younger, or must be within 10 years after obtaining the degree as of the date 2016/4/1”.

d)Publication list

※Please underline the applicant name. Put a circle (○) for the maximum of 3 papers which are relevant to the presentation. Limit the total number of the publications to 10 papers.

e)List of other awards achieved and currently under submission including those granted by other societies

【Records of awards achieved】

【Other awards under submission】

5. Your activities in BSJ

a)Presentation record in the past BSJ annual meetings

※Please describe the title, authors and meeting year, and underline the applicant name. Limit the total number of the listed presentations to 10.

b)List of publications in the journals published by BSJ

※Please underline the applicant name. If you have been awarded Early Career Award in Biophysics or Outstanding Presentation Award in the past, put a circle (○) to the related review or original research article published to “Biophysics and Physicobiology“ after the awards.

c)Activity record in the Society of Young Scientists in Biophysics (BP Wakate-no-kai)

d)Others

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