VIP Application Form

* All Fields are Compulsory
Educational Provider
   
Institution:
Department/School:
   
Person responsible for application
   
Name:
Position:
Phone:
Email:
Postal Address:
   
Proposed VIP
   
Name:
Position:
Phone:
Email:
Postal Address:
Brief Resume
(max 300 words)


Important
The proposed VIP should confirm their willingness to be involved by email to enquiries@futureintech.org.nz

   
Proposed Programme for VIP
(max 300 words)
   
Please explain how this person would be beneficial for your university
(max 200 words):
   
Budget
   
Please provide details of how the money applied for will be spent eg. time, travel, etc
 
Referee
   
Name:
Position:
Phone
Email:
Postal Address: