VLP Registration Form
● Please, if possible, submit this form at least two weeks before the time period in which you would like to give your talk.
● Please note that Knowledge Diffusion Network is a non-profit organization. We provide no monetary reimbursement to you for giving your talk.
Title
Name
Your answer
Email address
Your answer
University/Institute/Company
Your answer
Department/Group/Section
Your answer
City
Your answer
Country
Your answer
Position
Major/Field of Study
Which university department does it relate to?
Research Area
Your answer
Date of Visit (From)
Earliest date on which you can give your talk
MM
/
DD
/
YYYY
Date of Visit (To)
Latest date on which you can give your talk
MM
/
DD
/
YYYY
City(ies) or specific university/institution you would like to visit
Your answer
Potential host
Someone (or a university department etc.) who relates to your research topic
Your answer
Phone number
If you have a number in Iran, please also provide it here
Your answer
Title of your talk
In English, Persian, or both
Your answer
Abstract
Your answer
Short Bio
Maximum 5 lines
Your answer
Comments
Anything you would like us to know when contacting you or arranging you talk(s)?
Your answer
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