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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