GEOFFREY ROBERTS AWARD
Application Form			* = required
Name *
Age
Email *
Current Position & Place of Work
Address (For correspondence)
Telephone		Fax
Nationality
Please nominate someone, perhaps an employer or influential acquaintance in your chosen field, whom the judges could contact for more information about you:
Referee's name & address *
Telephone		Fax/Email
How did you hear about the award?
Describe your work at present giving details of both activities and responsibilities.
Give details of your previous employment, experience and qualifications.
If you won this travel bursary, please outline your proposal, budget and travel objectives
Describe why you would like to win the Geoffrey Roberts Award, how this would enhance your chosen career and the likely wider effects of your winning the Award. (Please note that the judges will be much more interested in the information given in response to 1 - 4 than in exactly how it is written or expressed.)