JINA-CEE Visitor Form
Fill out this form if you are visiting on JINA-CEE related business.
First Name *
Your answer
Last Name *
Your answer
Title
Your answer
Institutional Affiliation *
Your answer
Complete Mailing Address
Your answer
Work Phone Number
Your answer
Cell Phone Number
Your answer
Email Address
Your answer
Visit Information
Site Visiting *
JINA-CEE Host
Your answer
Beginning Date of Visit
MM
/
DD
/
YYYY
Ending Date of Visit
MM
/
DD
/
YYYY
Purpose of Visit (Scientific reason for visit) *
Your answer
Emergency Contact
Name, phone and email address requested
Your answer
Title of Seminar/Presentation, if applicable
Your answer
JINA-CEE Involvement
JINA-CEE support
(Please indicate if you are requesting financial support from JINA-CEE for any of the following.)
Other Information
(Please provide any other relevant information that will help us facilitate your visit.)
Your answer
Demographics
Type of Participant
Citizenship *
Are you a US Person (any individual who is a citizen of the United States, a permanent resident alien of the United States, or a protected individual as defined by 8 U.S.C. 1324b(a)(3)?
Citizenship(s)/residency(ies)
(list all countries currently holding citizenship/permanent residency, and indicate which is most recent)
Your answer
Gender
(Optional)
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