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Application Form for Access to International Arctic Research Facilities at Ny-Alesund, Norway

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(All fields are mandatory)
PRINCIPAL INVESTIGATOR (PI) DETAILS
Name Designation
Organization Division / Unit
Address line1 Address line2
City District
State Postal Code
Country Phone(Off)
e-mail Mobile
Fax    
 
CO - PRINCIPAL INVESTIGATOR (CO-PI) DETAILS
Name: Designation
Organization Division / Unit
Address line1 Address line2
City District
State Postal Code
Country Phone(Off)
e-mail Mobile
Fax    
 
PROJECT
Major Discipline:
Title of the Project:
Whether the project is ongoing or new proposal:
If the project is ongoing, please attach the accomplishment: (Multiple files can be attached)
(Upload only '.pdf','.doc','.xls','.jpg','.png' files)
Scientific Aims:
(* Maximum 200 Character Long)
Scientific Objectives:
(* Maximum 200 Character Long)
 
PROPOSED ONBOARD OBSERVATIONS AND SAMPLING ALONG THE CRUISE TRACK:
 
NAMES & AFFILIATIONS OF CRUISE PARTICIPANTS (PI/CO-PI/any Responsible Regular Scientific Staff Should Participate In The Expedition) :
 
  Name of the Scientific Staff: Institute Name:
 
DETAILS OF PASSPORT
 
Passport :
Passport Number:
Date of Issue:
Place of Issue:
Date of Expiry:
 
SAMPLE STORAGE REQUIREMENTS:
 
INSTRUMENTS PROPOSED TO BE CARRIED TO SOUTHERN OCEAN (NAME OF THE INSTRUMENT AND APPROXIMATE WEIGHT) :
 
Inst. Name Qty Make Model Inst. Sl.No Dimension Weight(Kg) Cost Remark
 

Signature of the PI :
 
Download Endorsement Form & Attach Below
 
Attach Certificates: (Multiple files can be attached)
(Upload only '.pdf','.doc','.xls',,'.jpg','.png' files)
 

Name
Signature
Head of the Institute/Organization
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