UMPhy mission Form (test)

Mission:

First name *

Last name *

Your email *

For non-permanent staff, please specify the referent

reason of the mission (Conference, school, workshop, contract meeting, thesis jury..)*

statut ?
PLENARYORALPOSTERATTENDEE
URL of conf, workshop... (optional)

Dates de début *

Dates de fin *

Informations for your dates - please indicate dates for mision and dates for privates stay (optional)

localisation (town) *

country *

free of charge ?
YESNO
If NOT, Imputation (indicate the contract) *

Informations for your travel (optional)