Application Form for ONO Pharmaceutical Travel Awards for Japanese Young Investigators

Application form for ONO Pharmaceutical Travel Awards for Japanese Young Investigators

Please type:

Name of the applicant:
Date of birth: / ( years old)
Position (indicate one): / Student / Post doc / Young faculty member (Joshu or Jokyo)
Affiliation:
Address:
E-mail:
Phone: / +81-
FAX: / +81-

Here I certify that I will attend the Bioactive Lipids in Cancer, Inflammation and related Diseases held between October 22-25, 2017 in Puerto Vallarta, Mexico, and will stand as a candidate for ONO Pharmaceutical Travel Awards for Japanese Young Investigators.

Date: / Signature:

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Please type:

Name of mentor/chair:
Position:
Affiliation:
Address:
E-mail:
Phone: / +81-
FAX: / +81-

Here I certify that I will support ______(insert name of the applicant) to attend the Bioactive Lipids in Cancer, Inflammation and related Diseases held between October 22-25, 2017 in Puerto Vallarta, Mexico and recommend her/him as an awardee of ONO Pharmaceutical Travel Awards for Japanese Young Investigators.

Date: / Signature:

Please send this completed form with your proposed abstract (in PDF format)

for consideration to . The deadline for the ONO Travel Award application with proposed abstract has been extended to July 14, 2017.

The Bioactive Lipids registration and abstract submission opened March 1, 2017. Registrants will have up to August 15, 2017 to officially submit their abstracts on the Bioactive Lipids submission portal. (NOTE: although you applied for an ONO Travel Award, you are required to submit your final abstract through the Bioactive Lipids submission portal once registration opens).