Travel grants are determined for IASA members only. Please read the Guidelines carefully before completing this form. Please print the application form out and fax or post to:

Secretary-General: Ilse Assmann
Media Libraries
South African Broadcasting Corporation
PO Box 931, 2006 Auckland Park, South Africa

Phone: +27 11 714 4041
Fax: +27 11 714 4419
e-mail: assmanni@sabc.co.za

GRANT APPLICATION FORM

Conference (title and location):

Dates of attendance:

Name:

Institution:

Address:


Country
if other

Phone:

Country Code
City Code
Fax Number

Fax:

Country Code
City Code
Fax Number

e-mail:

Repeat e-mail:

My IASA membership status is:

	Individual member
	Institutional member (If you represent an institutional member your application must be countersigned by the director or a senior officer of your organisation.)

Total amount of estimated travel costs (US$ or Euro):

(must be confirmed by an official travel agency)

I apply for the following amount (US$ or Euro):

(normally 50% of total travel costs are met)

I will present a paper:

	Yes
	No

Title of the paper:

State briefly the importance of this attendance to your own professional development and the impact it will have on your archival institution:

Signature of applicant:

______________________________

Date: _________________________

Signature of Institution (if applicable):

______________________________

Date: _________________________

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