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Combating Food and Energy Insecurity and Climate Change with

Sustainable and Inclusive Agricultural Technology and Innovation

The 3rd University Consortium Graduate Forum (UCGF)

17th 18th August 2017.
Venue: Kasetsart University

APPLICATION FORM

A. Personal Information

1. Name of applicant ______________________________________________________

(Family name) (First name) (Middle name)
2. Gender Male Female

3. Degree Program/Major MSc in _______________ PhD in ____________________

Specialization 1st year 2nd year 3rd year 4th year Graduating

4. Name of University _____________________________________________________

5. Faculty/Department ______________________________________________________

6. Home/Contact Address ______________________________________________________

(Please attach a copy of your passport number/details.)

7. E-mail Address ______________________________________________________

8. Mobile-Phone Number ______________________________________________________

9. Emergency Contact Persons ______________________________________________________
Name
______________________________________________________
10. Emergency Contact Phone
Number

11. Emergency Contact Email

______________________________________________________

B. Paper Presentation

12. Title of Paper to be presented _________________________________________________________

in the UCGF (Please provide an abstract of paper using the attached format.)

C. Other Information
(Please attach Abstract of paper with title and 3-5 keywords using the template provided. The abstract should not exceed
100 words).

__________________________________________
(Title)

__________________________________________
(Author)

_____________________________________________
(Degree Program; Affiliation/University; Address)

___________________________________
(E-mail Address)

Abstract

Keywords