Application Ref No:
ERSBLFKCL16/ /

BRITISH LUNG FOUNDATION-KING’S COLLEGE LONDON

European Respiratory Society 2016

Sleep and Ventilation Research Fellowship (Travel) application

/

Please complete this application form and returnan electronic version of your application AND ABSTRACTS as a SINGLE electronic file to - please do not send two separate files.

SUBMISSION DEADLINE:9am, MONDAY11July2016.

1)

Name (incl. title)
Post Held
Departmental contact postal address (including postcode)
E-mail address
Department/contact telephone no. / Department fax no.

2)

Qualifications(with dates)

3)

Previous positions held

4)

Please list ANY previous BLF travel fellowship award(s) receivedincluding details of relevant conference, year and destination (e.g. ATS 2016San Francisco, ERS 2015Amsterdam)

5)

Title of abstract(s) accepted for presentation at the 2016ERS meeting – please attach copies
Please indicate if each abstract has been accepted as a poster, thematic poster discussion or oral presentation (etc.).

6)

Current research activities – please give a brief summary of your current work, your future plans, research undertaken so far and list up to five recent publications.
Are you registered for a research degree?(If so, which one).

7)

a). Please state reasons for wanting to attend the ERSconference.
b). Is this your first attendance at the ERS? / YES/NO (please delete as appropriate)

8)

Winners of a BLF-King’s College London Travel Fellowship award are expected to acknowledge the BLF /orKing’s College Londonsupport appropriately (see point 7, application guidelines).
Please describe any other support that you would be willing to provide to the BLF. (E.g. participation in fundraising events, being a spokesperson etc.)
Signature / Date

For administrative purposes only

How did you find out about this award?
Are you/have you ever been involved in a British Lung Foundation sponsored research project? / Yes / No
Would you like to receive regular updates about BLF activities? / Yes / No

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