3.Member Since (Enter Year). Click Here to Join ESA Today

Note: Please type all information directly onto this Word doc. Once you’ve completed this document please save it.

1.Full Name:

2.Member ID:

3.Member Since (enter year). Click Here to Join ESA Today:

4.Position/Title:

5.Employer or University/Institutional Affiliation:

6.Mailing Address:

7.E-mail Address:

8.Phone:

9.Subject Matter/Field of Interest:

10.Enter your selection(s) below.

ESA Primary Branch:

ESA Secondary Branch:

ESA Primary Section:

ESA Secondary Section:

11.Indicate anticipated participation at the Congress meeting with an X.

____ Invited

____ Submitted

____ Paper

____ Poster

12.Enter your Paper Title(s), and Symposium Title(s) and Section number(s) below if applicable:

13.Below enter your role at the Congress other than presenting:

14.List any presentations (poster or oral) made between 2009 – 2011 at ESA Annual Meetings:

15.Please read the information below carefully and upload the requested documents as a single PDF. Document should conform to standard margins (1 inch or 2.5 cm) and use only standard fonts with a font size no smaller than 11.5:

I.A short table with your expected expenses (registration, airfare, lodging and incidentals). Please include any other funding you have available (indicate amount received) or expect to receive for this trip (indicate amount requested).

II.A two-page biographical resume, citing education, employment, and the most relevant publications, presentations, awards, current grant(s), scholarships, and outside funding received during the preceding 36 months.

III.A one page Statement of Activities to describe:

a)The scope and importance of the research you propose to present at the Congress.

b)How attendance at the Congress will benefit your professional work.

c)How your participation in the Congress benefits the science of entomology.

d)Describe any professional contacts that you intend to make either during the Congress meeting or while in Korea.

IV.A one page letter of recommendation in support of your application from a mentor or supervisor (Dept. Chair for Assistant Professors). Criteria to be addressed include:

a)affirm that the candidate is eligible for the award

b)indicate how this award will benefit the applicant

c)why this applicant should receive this award

d)Please share any additional information you would like to communicate to the selection committee.

When you have completed filling out this form, convert it into a PDF and combine it with your expense table, two page biographical resume, Statement of Activities, and your Letter of Recommendation. Submit completed package on the ESA website at

by midnight February 22 (U.S. Eastern Standard Time).