1. Surname:

First Names:

Member of Linnean Society of NSW? Yes / No

2. Postal Address:
 
 
 
 

E-mail:

Telephone (business hours): (              )

4. Relevant research experience & publications:
 
 
 
 
 
 
 
 
 
 

5. Supervisor/Collaborator (if any):

6. Names, addresses & telephone numbers of two referees:

(1)
 
 

(2)
 
 

8. Aims, outline, expected outcomes & duration of proposed research (up to three extra pages may be attached):
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

9. Proposed budget & justification
 
 
 
 
 
 
 
 
 
 
 
 

10. Amount requested from Betty Mayne Fund: $

11. Other research grants currently held and/or applied for:
 
 
 
 
 
 
 
 

12. Institutional support for project:
 
 
 
 
 
 
 
 

I hereby apply for a Betty Mayne Scientific Research Grant and agree to the following conditions:

i) To apply to the project described above any grant monies that are awarded;

ii) To acknowledge said grant in any relevant publication;

iii) To provide a progress report on the project to the Society within twelve months of the grant being awarded.
 
 

SIGNATURE OF APPLICANT..........................................................................DATE......./........./............

If applicant is a student:

The applicant will be carrying out the above research project under my supervision.
 
 

SIGNATURE OF SUPERVISOR.........................................................................DATE......./........./............

This typed application form must be completed in sufficient detail to provide a 'stand alone' proposal. Up to three extra pages (plus references and publication list) may be attached to provide additional information.

Completed applications (original plus four (4) photocopies) should be posted to the Secretary of the Society at the address below. Normally the closing date for applications is 1st  March. However, applications for emergency support may be received at any time.

The Secretary