First Name:     Last Name:     Title:      Gender: 

Institutional Affiliation:    

Complete Mailing Address:    

Phone Number:   

FAX Number:   

E-mail:   

URL of personal web page (if any): 

Please give details as to the purpose of
your visit (Area of Expertise).

(You may enter up to 150 characters.)

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If you will give a seminar/colloquium, please provide
title of talk.

Site to Visit:       Notre Dame        Michigan State University        University of Chicago

JINA Host:    

Proposed Duration/Dates of Visit:    

What are your housing requirements?

Citizenship:      US Citizen      US Permanent Resident  

Country:      VISA Status:

  Status:      Faculty        Postdoc        Visitor        Staff       

                Graduate Student        Undergrad        High School        Teacher

  JINA Involvement:     

                JINA Investigator        JINA Associate        JINA Interest Group       

                JINA Colloborator        Non JINA Associated Institute        JINA Visitor

                JINA Speaker (Seminar/Talk)        Event Participant        Other

Wireless Access:      Please check here if you need wireless internet access during your visit.

VISA TRAVEL FOR FOREIGN VISITORS:

If you do not have a US passport or permanent resident card, you will need to enter the US as a visitor on a business visa (either B1 or WB). When you arrive in the US, you must state that you are entering for business purposes (i.e. a B1 designation on the 1-94 card) or under the visa waiver program and you are requesting a waiver for business purposes (i.e. a WB designation on the I-94 card) and take a letter of invitation from the host institution with you when you apply. This status will enable us to reimburse (travel, meals, lodging) if you have not accepted payments from more than 5 US entities in the previous 6 months. We must have a copy of your passport page, visa page and 1-94 card to reimburse expenses. Click here to read more information.

       Please check here if you will need a letter of invitation.