KIPAC Visitor Request Form

Please help us in organizing a vibrant KIPAC visitor and speaker program by completing this form if any of these apply --

The form will be reviewed by the KIPAC Management Team and a KIPAC member will contact you.

Visitor/Speaker Full Name:

Email address:

Institution:

Job Title:

Postdoc

Graduate Student

Other…

Describe your request:

Web Page:

Tell us more about your interest in visiting KIPAC:

e.g., research interests, potential collaborations, other interactions?

Are you or the visitor interested in giving one of these types of talks?

Please list a contact at KIPAC:

This is required if requesting to give a talk.

What topics do you or the visitor primarily work on?

Start date of the visit:

If uncertain, please give approximate dates

Departure Date:

Approximate Length of Stay:

Additional Information:

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