Application form 2023 Last name (as in your passport)(required)First name (as in your passport)(required)Name as it should appear on the badge (first name, last name)(required)Institution(required)Email address(valid email required)Which stakeholder group are you representing?academiabusinessgovernmentcivil societytechnical communityothers(required)Geografical region of nationalityAfricaAsia / PacificEuropeLatin AmericaMiddle East and North Africa (MENA)North AmericaOceania(required)NationalityAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte D'IvoireCroatiaCubaCyprusCzech RepublicDemocratic People's Republic of KoreaDemocratic Republic of the Congo DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMonacoMongogliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of KoreaRepublic of MoldovaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyrian Arab RepublicTajikistanThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States of AmericaUnited Republic of TanzaniaUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamYemenZambiaZimbabwe(required)Country of residenceAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte D'IvoireCroatiaCubaCyprusCzech RepublicDemocratic People's Republic of KoreaDemocratic Republic of the Congo DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMonacoMongogliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of KoreaRepublic of MoldovaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyrian Arab RepublicTajikistanThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States of AmericaUnited Republic of TanzaniaUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamYemenZambiaZimbabwe(required)Post address (to be used for visa purposes and invitation letter)(required)Phone number(required)GendermalefemaleotherAge(required)Do you have any special needs? (dietary needs, physical assistance)(required)Please confirm you are able to follow the programme and interact in English? (We provide no interpretation.)yesnoDo you need a visa?yesnoDid you attend another School on Internet Governance? If yes, when and which one?(required)PAYMENT AND FELLOWSHIP OPTIONS: Application for a fellowship (full or partly) is possible for fellows from countries of emerging economies until 31st March 2023. Since there is only a limited number of fellowships available, we encourage everyone to consider the self-funding of travel costs or to apply for the reduced students fee. This will increase the chance to be selected significantly! Applications from self-paying fellows will be accepted until 31st May 2023.I apply (please select)to pay the full fee 5.000 EUR, plus 19% VAT (for corporations / WEOG governments; it contains no sponsoring components)to pay the standard fee 2.500 EUR, plus 19% VAT (for NGO’s and our sponsors; half of the fee is supported by the overall budget)to pay the students fee 500 EUR, plus 19% VAT (for students; most of the fee is supported by the overall budget)for the fellowship EXCLUDING travel costsfor the fellowship INCLUDING travel costs(required)IMPORTANT NOTE: In case of cancellation we keep a handling fee of 10% of the netto sum. Please provide your academic background: (100 words maximum, aviod bullet points and numeration)(required)What is your motivation to participate at the EuroSSIG? (100 words maximum, aviod bullet points and numeration)(required)>> In case I am selected I agree to the publication of my name, institution and academic background provided in this application. I also give consent to be included in the non-public mailing list, containing all fellows and the faculty of the 2023 edition, with the email address provided in this form. >> I agree to the processing of the data given in this form according to the privacy policy.
