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Third Academic Conference on International Mediation
Rio de Janeiro, 17-19 July 2017
Application form
Contact information
Please submit this application form electronicallyuntil 24 March 2017 to
If you would like to attend the Conference as a LISTENER, without submitting and presenting any papers, you may leave the “Abstract” field blank, and fill all “Participant 1” fields with your contact information. Each listener must submit a separate application form.
If you are submitting an abstract and intend to present your paper at the Conference, please fill the fields below with contact information of all co-authors of your paper and indicate which of the authors would participate as PRESENTERS. Co-authors may present their paper together, as long as they limit their total presentation time to 20 minutes. You must include the requested contact information for all co-authors of submitted abstracts.
ABSTRACT:(Up to 300 words. Please include a title.)
PARTICIPANT 1:
FULL NAME:
CITIZENSHIP:
TITLE:
INSTITUTIONAL AFFILIATION:
CORRESPONDENCE ADDRESS:
TELEPHONE NUMBER:
EMAIL:
ID (if Brazilian) or PASSPORT No (please attach a copy of your document’s main pages):
EXACT TRAVEL DATES TO RIO (if applicable):
Does this participant intend toattend the Conference, either as a listener or as a presenter?
[ ] Yes, as a presenter.
[ ] Yes, as a listener.
[ ] No, this author will not attend the Conference. Our paper will be presented by another co-author.
PARTICIPANT2:(in case there is a co-author for the same paper)
FULL NAME:
CITIZENSHIP:
TITLE:
INSTITUTIONAL AFFILIATION:
CORRESPONDENCE ADDRESS:
TELEPHONE NUMBER:
EMAIL:
ID (if Brazilian) or PASSPORT No: (please attach a copy of your document’s main pages):
EXACT TRAVEL DATES TO RIO (if applicable):
Does this participant intend to attend the Conference, either as a listener or as a presenter?
[ ] Yes, as a presenter.
[ ] Yes, as a listener.
[ ] No, this author will not attend the Conference. Our paper will be presented by another co-author.
PARTICIPANT 3:(in case there is a co-author for the same paper)
FULL NAME:
CITIZENSHIP:
TITLE:
INSTITUTIONAL AFFILIATION:
CORRESPONDENCE ADDRESS:
TELEPHONE NUMBER:
EMAIL:
ID (if Brazilian) or PASSPORT No: (please attach a copy of your document’s main pages):
EXACT TRAVEL DATES TO RIO (if applicable):
Does this participant intend to attend the Conference, either as a listener or as a presenter?
[ ] Yes, as a presenter.
[ ] Yes, as a listener.
[ ] No, this author will not attend the Conference. Our paper will be presented by another co-author.
Next steps
Submit this Application Form(signed by at least one of the authors, in the case of a co-authored paper) by 24 March 2017, to . Any further questions must be sent to the same email address.
Attach to this application form a copy of the ID or Passport’s main pages of all participants. If your abstract is accepted, this information will be on your invitation letter.
A notification of acceptance will be made at the latest on 10 April 2017. If your abstract is accepted, your full paper must be submitted by 18 June 2017.
Place: ______Date: ______
Signature:______
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