This form should be completed by the AMICAL Representative.
Who will be representing your institution as your proxy?
Your proxy must participate in the Members Council meeting. If no one from your institution can attend, please explain this in the comments below.
Information about the AMICAL 2020 attendee(s) whose airfare is being covered by your institution:
By submitting this form, you confirm that you recognize all of the following:
AMICAL will use the information you provide on this form to organize the event, as described in our Privacy Policy. We will use your contact information to send you updates about this event. We will share your information with AUC and the workshop organizers only for the same uses.
After submitting the form you will be taken to a “Thank you!” page, indicating that the submission was successful. If you do not reach this page, then something has gone wrong. Consult our form troubleshooting page to find out how to proceed.