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href="/events/exhibitor_submission_complete/"> Thank you for your Submis... </a> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/asynchronous_invited_speaker_recording_preference/"> Asynchronous Invited Spea... </a> <button type="button" data-toggle="collapse" data-target="#item-8" class="d-none d-sm-inline-block btn btn-link " aria-expanded="false" aria-controls="item-8"> <i class="fal fa-chevron-down" aria-hidden="true"></i> </button> <div id="item-8" class="collapse "> <ul class="nav nav-pills flex-column ml-3"> <li> <a class="nav-item nav-link " href="/events/asynchronous_invited_speaker_recording_preference/asynchronous_invited_speaker_confirmation/"> Asynchronous Invited Speaker Recording Preference Confirmation </a> </li> </ul> </div> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/the_anomalous_diffusion_workshop_(andi_workshop)/"> The Anomalous Diffusion W... </a> </li> </ul> </div> <div class="dropdown d-lg-none"> <button class="btn btn-outline-primary dropdown-toggle px-1 mb-2 w-100" type="button" id="subNavButton" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false"> > Menu </button> <div class="dropdown-menu px-0 py-1 w-100" aria-labelledby="subNavButton"> <ul class="nav nav-pills flex-column"> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/congress/"> Congress </a> <ul class="nav nav-pills flex-column ml-2"> <li> <a class="nav-item nav-link " href="/events/congress/advanced_photonics_congress/"> Optica Advanced Photonics Congress </a> </li> <li> <a class="nav-item nav-link " href="/events/congress/biophotonics_congress_biomedical_optics/"> Optica Biophotonics Congress: Biomedical Optics </a> </li> <li> <a class="nav-item nav-link " href="/events/congress/biophotonics_congress/"> Optica Biophotonics Congress: Optics in the Life Sciences </a> </li> <li> <a class="nav-item nav-link " href="/events/congress/optical_design_and_fabrication_congress/"> Optica Design and Fabrication Congress </a> </li> <li> <a class="nav-item nav-link " href="/events/congress/high-brightness_sources_and_light-driven_interacti/"> Optica High-Brightness Sources and Light-Driven Interactions Congress </a> </li> <li> <a class="nav-item nav-link " href="/events/congress/imaging_and_applied_optics_congress/"> Optica Imaging Congress </a> </li> <li> <a class="nav-item nav-link " href="/events/congress/laser_congress/"> Optica Laser Congress and Exhibition </a> </li> <li> <a class="nav-item nav-link " href="/events/congress/optical_sensors_and_sensing_congress/"> Optica Sensing Congress </a> </li> </ul> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/incubator_meetings/"> Incubator Meetings </a> <ul class="nav nav-pills flex-column ml-2"> <li> <a class="nav-item nav-link " href="/events/incubator_meetings/propose_an_incubator_meeting/"> Propose an Incubator Meeting </a> </li> <li> <a class="nav-item nav-link " href="/events/incubator_meetings/past_incubator_meetings/"> Past Incubator Meetings </a> </li> <li> <a class="nav-item nav-link " href="/events/incubator_meetings/additional_information/"> Additional Information </a> </li> </ul> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/industry_events/"> Industry Events </a> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/meeting_archives/"> Archives </a> <ul class="nav nav-pills flex-column ml-2"> <li> <a class="nav-item nav-link " href="/events/meeting_archives/archive_by_year/"> Archive by Year </a> </li> </ul> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 font-weight-bold" href="/events/meeting_opportunities/"> Meeting Services </a> <ul class="nav nav-pills flex-column ml-2"> <li> <a class="nav-item nav-link font-weight-bold" href="/events/meeting_opportunities/conference_proposal_form/"> Conference Proposal Submission </a> </li> <li> <a class="nav-item nav-link " href="/events/meeting_opportunities/exhibitor_sponsor_information/"> Exhibitor/Sponsor Information </a> </li> <li> <a class="nav-item nav-link " href="/events/meeting_opportunities/meeting_grants/"> Global Meeting Grants </a> </li> <li> <a class="nav-item nav-link " href="/events/meeting_opportunities/idea_center/"> Idea Center </a> </li> <li> <a class="nav-item nav-link " href="/events/meeting_opportunities/meeting_and_paper_management_options/"> Meeting and Paper Management Services </a> </li> <li> <a class="nav-item nav-link " href="/events/meeting_opportunities/request_an_endorsement/"> Request an Endorsement </a> </li> </ul> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/mobile_app/"> Mobile App </a> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/code_of_conduct/"> Code of Conduct </a> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/exhibitor_submission_complete/"> Thank you for your Submission </a> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/asynchronous_invited_speaker_recording_preference/"> Asynchronous Invited Speaker Recording Preference </a> <ul class="nav nav-pills flex-column ml-2"> <li> <a class="nav-item nav-link " href="/events/asynchronous_invited_speaker_recording_preference/asynchronous_invited_speaker_confirmation/"> Asynchronous Invited Speaker Recording Preference Confirmation </a> </li> </ul> </li> <li class="nav-item"> <a class="nav-link d-inline-flex mr-0 pr-0 " href="/events/the_anomalous_diffusion_workshop_(andi_workshop)/"> The Anomalous Diffusion Workshop (AnDi Workshop) </a> </li> </ul> </div> </div> </div> <div class="col-lg-8" id="BodyContent"> <div class="container"> <div class="row py-2 py-md-3"> <h2>Conference Proposal Submission Form</h2> <h3>General Information</h3> <p>* Required</p> <form method="post" enctype="multipart/form-data" action="/events/meeting_opportunities/conference_proposal_form/"> <input name="__Kentico_DC_Page" type="hidden" value="CfDJ8LGFn+57k3FEjr9z+4vMwflkFnqoduFgg8jUwfAxGKf3ClZwmdFXZka2z+PTtcGHnreWsofovvTAoxKT6gJJLQRsdykdQDyp52pCtNYF0Kcb+kwNx2iXvMpPNgEUrauKzA==" /> <div class="form-group"> <label class="control-label" for="ConferenceName">Conference Name *:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Conference Name *: must be a string or array type with a maximum length of '510'." data-val-maxlength-max="510" data-val-required="Conference Name is required." id="ConferenceName" maxlength="510" name="ConferenceName" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="ConferenceName" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="Acronym">Conference Acronym:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Conference Acronym: must be a string or array type with a maximum length of '50'." data-val-maxlength-max="50" id="Acronym" maxlength="50" name="Acronym" value="" /> </div> <div class="form-group"> <div>(Requested) Location:</div> <label class="control-label" for="EventFormat">Event format? *</label> <label><input value="online" type="radio" data-val="true" data-val-required="Event format is required." id="EventFormat" name="EventFormat" />online</label> <label><input value="hybrid" type="radio" id="EventFormat" name="EventFormat" />hybrid</label> <label><input value="in-person" type="radio" id="EventFormat" name="EventFormat" />in-person</label> <span class="text-danger field-validation-valid" data-valmsg-for="EventFormat" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="ConferenceCity">City *:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field City *: must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="City is required." id="ConferenceCity" maxlength="100" name="ConferenceCity" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="ConferenceCity" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="ConferenceState">State/International Province:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field State/International Province: must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" id="ConferenceState" maxlength="100" name="ConferenceState" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="ConferenceState" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="ConferenceCountry">Country *:</label> <select data-val="true" data-val-required="Country is required." id="ConferenceCountry" name="ConferenceCountry"> <option value=""></option> <option value="EGYPT">Arab Republic of Egypt</option> <option value="ARGENTINA">Argentine Republic</option> <option value="AZERBAIJAN">Azerbaijani Republic</option> <option value="BARBADOS">Barbados</option> <option value="BELIZE">Belize</option> <option value="BERMUDA">Bermuda</option> <option value="VENEZUELA">Bolivarian Republic of Venezuela</option> <option value="BOSNIA AND HERZEGOVINA">Bosnia and Herzegovina</option> <option value="BRITISH VIRGIN ISLANDS">British Virgin Islands</option> <option value="BURKINA FASO">Burkina Faso</option> <option value="CANADA">Canada</option> <option value="CAYMAN ISLANDS">Cayman Islands</option> <option value="CENTRAL AFRICAN REPUBLIC">Central African Republic</option> <option value="DOMINICA">Commonwealth of Dominica</option> <option value="AUSTRALIA">Commonwealth of Australia</option> <option value="BAHAMAS">Commonwealth of the Bahamas</option> <option value="COMOROS">Comoros</option> <option value="COOK ISLANDS">Cook Islands</option> <option value="CUBA">Cuba</option> <option value="CURACAO">Curacao</option> <option value="CZECH REPUBLIC">Czech Republic</option> <option value="DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA">Democratic People's Republic of Korea</option> <option value="CONGO, DEM REP">Democratic Republic of the Congo</option> <option value="TIMOR-LESTE">Democratic Republic of Timor-Leste</option> <option value="DOMINICAN REPUBLIC">Dominican Republic</option> <option value="URUGUAY">Eastern Republic of Uruguay</option> <option value="ECUADOR">Ecuador</option> <option value="ERITREA">Eritrea</option> <option value="ETHIOPIA">Ethopia</option> <option value="GERMANY">Federal Republic of Germany</option> <option value="NIGERIA">Federal Republic of Nigeria</option> <option value="FEDERATED STATES OF MICRONESIA">Federated States of Micronesia</option> <option value="BRAZIL">Federative Republic of Brazil</option> <option value="MACEDONIA">Former Yugoslav Republic of Macedonia</option> <option value="REUNION">French Department of Reunion</option> <option value="FRENCH POLYNESIA">French Polynesia</option> <option value="FRANCE">French Republic</option> <option value="GABON">Gabonese Republic</option> <option value="GEORGIA">Georgia</option> <option value="GHANA">Ghana</option> <option value="GIBRALTAR">Gibraltar</option> <option value="LUXEMBOURG">Grand Duchy of Luxembourg</option> <option value="LIBYA">Great Socialist People's Libyan Arab Jamahiriya</option> <option value="GREENLAND">Greenland </option> <option value="GRENADA">Grenada</option> <option value="GUYANA">Guyana</option> <option value="JORDAN">Hashemite Kingdom of Jordan</option> <option value="GREECE">Hellenic Republic</option> <option value="HONG KONG">Hong Kong</option> <option value="SAMOA">Independent State of Samoa</option> <option value="IRELAND">Ireland</option> <option value="IRAN">Islamic Republic of Iran</option> <option value="MAURITANIA">Islamic Republic of Mauritania</option> <option value="PAKISTAN">Islamic Republic of Pakistan</option> <option value="AFGHANISTAN">Islamic State of Afghanistan</option> <option value="ITALY">Italian Republic</option> <option value="JAMAICA">Jamaica</option> <option value="JAPAN">Japan</option> <option value="BELGIUM">Kingdom of Belgium</option> <option value="BHUTAN">Kingdom of Bhuran</option> <option value="CAMBODIA">Kingdom of Cambodia</option> <option value="DENMARK">Kingdom of Denmark</option> <option value="LESOTHO">Kingdom of Lesotho</option> <option value="MOROCCO">Kingdom of Morocco</option> <option value="NORWAY">Kingdom of Norway</option> <option value="SAUDI ARABIA">Kingdom of Saudi Arabia</option> <option value="SPAIN">Kingdom of Spain</option> <option value="SWAZILAND">Kingdom of Swaziland</option> <option value="SWEDEN">Kingdom of Sweden</option> <option value="THAILAND">Kingdom of Thailand</option> <option value="NETHERLANDS">Kingdom of the Netherlands</option> <option value="TONGA">Kingdom of Tonga</option> <option value="KYRGYZSTAN">Kyrgyz Republic</option> <option value="LAOS">Lao People's Democratic Republic</option> <option value="LEBANON">Lebanon</option> <option value="MACAU">Macau</option> <option value="MALAWI">Malawi</option> <option value="MALAYSIA">Malaysia</option> <option value="MALTA">Malta</option> <option value="MONGOLIA">Mongolia</option> <option value="BRUNEI">Negara Brunei Darussalam</option> <option value="NEPAL">Nepal</option> <option value="NEW CALEDONIA">New Caledonia</option> <option value="NEW ZEALAND">New Zealand</option> <option value="NICARAGUA">Nicaragua</option> <option value="NIUE">Niue</option> <option value="PAPUA NEW GUINEA">Papua New Guinea</option> <option value="ALGERIA">People's Democratic Republic of Algeria</option> <option value="BANGLADESH">People's Republic of Bangladesh</option> <option value="CHINA">People's Republic of China</option> <option value="PORTUGAL">Portuguese Republic</option> <option value="ANDORRA">Principality of Andorra</option> <option value="LIECHTENSTEIN">Principality of Liechtenstein</option> <option value="MONACO">Principality of Monaco</option> <option value="ALBANIA">Republic of Albania</option> <option value="ANGOLA">Republic of Angola</option> <option value="ARMENIA">Republic of Armenia</option> <option value="AUSTRIA">Republic of Austria</option> <option value="BELARUS">Republic of Belarus</option> <option value="BENIN">Republic of Benin</option> <option value="BOLIVIA">Republic of Bolivia</option> <option value="BOTSWANA">Republic of Botswana</option> <option value="BULGARIA">Republic of Bulgaria</option> <option value="BURUNDI">Republic of Burundi</option> <option value="CABO VERDE">Republic of Cabo Verde</option> <option value="CAMEROON">Republic of Cameroon</option> <option value="CHAD">Republic of Chad</option> <option value="CHILE">Republic of Chile</option> <option value="TAIWAN">Republic of China</option> <option value="COLOMBIA">Republic of Colombia</option> <option value="COSTA RICA">Republic of Costa Rica</option> <option value="COTE D'IVOIRE">Republic of Côte d'Ivoire</option> <option value="CROATIA">Republic of Croatia</option> <option value="CYPRUS">Republic of Cyprus</option> <option value="DJIBOUTI">Republic of Djibouti</option> <option value="EL SALVADOR">Republic of El Salvador</option> <option value="EQUATORIAL GUINEA">Republic of Equatorial Guinea</option> <option value="ESTONIA">Republic of Estonia</option> <option value="FIJI">Republic of Fiji</option> <option value="FINLAND">Republic of Finland</option> <option value="GUATEMALA">Republic of Guatemala</option> <option value="GUINEA">Republic of Guinea</option> <option value="GUINEA-BISSAU">Republic of Guinea-Bissau</option> <option value="HAITI">Republic of Haiti</option> <option value="HONDURAS">Republic of Honduras</option> <option value="HUNGARY">Republic of Hungary</option> <option value="ICELAND">Republic of Iceland</option> <option value="INDIA">Republic of India</option> <option value="INDONESIA">Republic of Indonesia</option> <option value="IRAQ">Republic of Iraq</option> <option value="KAZAKHSTAN">Republic of Kazakhstan</option> <option value="KENYA">Republic of Kenya</option> <option value="KIRIBATI">Republic of Kiribati</option> <option value="REPUBLIC OF KOREA">Republic of Korea</option> <option value="KOSOVO">Republic of Kosovo</option> <option value="LATVIA">Republic of Latvia</option> <option value="LIBERIA">Republic of Liberia</option> <option value="LITHUANIA">Republic of Lithuania</option> <option value="MADAGASCAR">Republic of Madagascar</option> <option value="MALDIVES">Republic of Maldives</option> <option value="MALI">Republic of Mali</option> <option value="MAURITIUS">Republic of Mauritius</option> <option value="MOLDOVA">Republic of Moldova</option> <option value="MONTENEGRO">Republic of Montenegro</option> <option value="MOZAMBIQUE">Republic of Mozambique</option> <option value="NAMIBIA">Republic of Namibia</option> <option value="NAURU">Republic of Nauru</option> <option value="PALAU">Republic of Palau</option> <option value="PANAMA">Republic of Panama</option> <option value="PARAGUAY">Republic of Paraguay</option> <option value="PERU">Republic of Peru</option> <option value="POLAND">Republic of Poland</option> <option value="SENEGAL">Republic of Senegal</option> <option value="SERBIA">Republic of Serbia</option> <option value="SEYCHELLES">Republic of Seychelles</option> <option value="SINGAPORE">Republic of Singapore</option> <option value="SLOVENIA">Republic of Slovenia</option> <option value="SOUTH AFRICA">Republic of South Africa</option> <option value="SOUTH SUDAN">Republic of South Sudan</option> <option value="SURINAME">Republic of Suriname</option> <option value="CONGO">Republic of the Congo</option> <option value="GAMBIA">Republic of the Gambia</option> <option value="MARSHALL ISLANDS">Republic of the Marshall Islands</option> <option value="NIGER">Republic of the Niger</option> <option value="PHILIPPINES">Republic of the Philippines</option> <option value="SUDAN">Republic of the Sudan</option> <option value="MYANMAR">Republic of the Union of Myanmar</option> <option value="UGANDA">Republic of Uganda</option> <option value="UZBEKISTAN">Republic of Uzbekistan</option> <option value="VANUATU">Republic of Vanuatu</option> <option value="YEMEN">Republic of Yemen</option> <option value="ZAMBIA">Republic of Zambia</option> <option value="ZIMBABWE">Republic of Zimbabwe</option> <option value="ROMANIA">Romania</option> <option value="RUSSIA">Russian Federation</option> <option value="RWANDA">Rwandese Republic</option> <option value="SAINT HELENA">Saint Helena</option> <option value="SAINT LUCIA">Saint Lucia</option> <option value="SAINT VINCENT AND THE GRENADINES">Saint Vincent and the Grenadines</option> <option value="SAO TOME AND PRINCIPE">Sao Tome and Principe</option> <option value="SIERRA LEONE">Sierra Leone</option> <option value="SINT MAARTEN">Sint Maarten</option> <option value="SLOVAKIA">Slovak Republic</option> <option value="VIETNAM">Socialist Republic of Vietnam</option> <option value="SOLOMON ISLANDS">Solomon Islands</option> <option value="SOMALIA">Somali Democratic Republic</option> <option value="SRI LANKA">Sri Lanka</option> <option value="BAHRAIN">State of Bahrain</option> <option value="ISRAEL">State of Israel</option> <option value="KUWAIT">State of Kuwait</option> <option value="QATAR">State of Qatar</option> <option value="OMAN">Sultanate of Oman</option> <option value="SWITZERLAND">Swiss Confederation</option> <option value="SYRIA">Syrian Arab Republic</option> <option value="TAJIKISTAN">Tajikistan</option> <option value="HOLY SEE (VATICAN CITY)">The Holy See (Vatican City State)</option> <option value="TOGO">Togolese Republic</option> <option value="TOKELAU">Tokelau</option> <option value="TRINIDAD AND TOBAGO">Trinidad and Tobago</option> <option value="TUNISIA">Tunisia</option> <option value="TURKEY">Turkey</option> <option value="TURKMENISTAN">Turkmenistan</option> <option value="TUVALU">Tuvalu</option> <option value="UKRAINE">Ukraine</option> <option value="UNITED ARAB EMIRATES">United Arab Emirates</option> <option value="UNITED KINGDOM">United Kingdom of Great Britain and Northern Ireland</option> <option value="MEXICO">United Mexican States</option> <option value="TANZANIA">United Republic of Tanzania</option> <option value="UNITED STATES">United States of America</option> </select> <span class="text-danger field-validation-valid" data-valmsg-for="ConferenceCountry" data-valmsg-replace="true"></span> </div> <div class="form-group"> <div>(Requested) Event Dates:</div> <label class="control-label" for="StartDate">Start Date *:</label> <input type="date" class="form-control" data-val="true" data-val-required="Start Date is required." id="StartDate" name="StartDate" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="StartDate" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="EndDate">End Date *:</label> <input type="date" class="form-control" data-val="true" data-val-required="End Date is required." id="EndDate" name="EndDate" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="EndDate" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="PreviousNoAttendees">Final Number of Attendees at previous meeting (if one in a series):</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Final Number of Attendees at previous meeting (if one in a series): must be a string or array type with a maximum length of '50'." data-val-maxlength-max="50" id="PreviousNoAttendees" maxlength="50" name="PreviousNoAttendees" value="" /> </div> <div class="form-group"> <label class="control-label" for="EstimatedNoAttendees">Estimated Number of Attendees (Regular and Students):</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Estimated Number of Attendees (Regular and Students): must be a string or array type with a maximum length of '50'." data-val-maxlength-max="50" id="EstimatedNoAttendees" maxlength="50" name="EstimatedNoAttendees" value="" /> </div> <div class="form-group"> <label class="control-label" for="WebSite">Conference Web site:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Conference Web site: must be a string or array type with a maximum length of '255'." data-val-maxlength-max="255" id="WebSite" maxlength="255" name="WebSite" value="" /> </div> <div class="form-group"> <label class="control-label" for="EstimatedNoExhibits">Estimated Number of Exhibits (if applicable):</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Estimated Number of Exhibits (if applicable): must be a string or array type with a maximum length of '20'." data-val-maxlength-max="20" id="EstimatedNoExhibits" maxlength="20" name="EstimatedNoExhibits" value="" /> </div> <div class="form-group"> <label class="control-label" for="ExpectedNoPresentations">Expected number of presentations (contributed, invited, plenary, tutorial, poster, etc):</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Expected number of presentations (contributed, invited, plenary, tutorial, poster, etc): must be a string or array type with a maximum length of '50'." data-val-maxlength-max="50" id="ExpectedNoPresentations" maxlength="50" name="ExpectedNoPresentations" value="" /> </div> <div class="form-group"> <label class="control-label" for="EnglishLanguage">Will English be an accepted language for presentations at this meeting? *</label> <label><input value="true" type="radio" data-val="true" data-val-required="Will English be an accepted language for presentations at this meeting is required." id="EnglishLanguage" name="EnglishLanguage" />Yes</label> <label><input value="false" type="radio" id="EnglishLanguage" name="EnglishLanguage" />No</label> <span class="text-danger field-validation-valid" data-valmsg-for="EnglishLanguage" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="OtherLanguages">What other language(s) will presentations be given in during the conference?</label> <input class="form-control" type="text" id="OtherLanguages" name="OtherLanguages" value="" /> </div> <div class="form-group"> <label class="control-label" for="ContactName">Contact Name *:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Contact Name *: must be a string or array type with a maximum length of '50'." data-val-maxlength-max="50" data-val-required="Contact Name is required." id="ContactName" maxlength="50" name="ContactName" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="ContactName" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="ContactAffiliation">Affiliation:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Affiliation: must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" id="ContactAffiliation" maxlength="100" name="ContactAffiliation" value="" /> </div> <div class="form-group"> <label class="control-label" for="ContactAddress1">Street Address:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Street Address: must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" id="ContactAddress1" maxlength="100" name="ContactAddress1" value="" /> </div> <div class="form-group"> <label class="control-label" for="ContactAddress2">Suite #:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Suite #: must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" id="ContactAddress2" maxlength="100" name="ContactAddress2" value="" /> </div> <div class="form-group"> <label class="control-label" for="ContactCity">City:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field City: must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" id="ContactCity" maxlength="100" name="ContactCity" value="" /> </div> <div class="form-group"> <label class="control-label" for="ContactState">State/International Province:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field State/International Province: must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" id="ContactState" maxlength="100" name="ContactState" value="" /> </div> <div class="form-group"> <label class="control-label" for="ContactCountry">Country:</label> <select id="ContactCountry" name="ContactCountry"> <option value=""></option> <option value="EGYPT">Arab Republic of Egypt</option> <option value="ARGENTINA">Argentine Republic</option> <option value="AZERBAIJAN">Azerbaijani Republic</option> <option value="BARBADOS">Barbados</option> <option value="BELIZE">Belize</option> <option value="BERMUDA">Bermuda</option> <option value="VENEZUELA">Bolivarian Republic of Venezuela</option> <option value="BOSNIA AND HERZEGOVINA">Bosnia and Herzegovina</option> <option value="BRITISH VIRGIN ISLANDS">British Virgin Islands</option> <option value="BURKINA FASO">Burkina Faso</option> <option value="CANADA">Canada</option> <option value="CAYMAN ISLANDS">Cayman Islands</option> <option value="CENTRAL AFRICAN REPUBLIC">Central African Republic</option> <option value="DOMINICA">Commonwealth of Dominica</option> <option value="AUSTRALIA">Commonwealth of Australia</option> <option value="BAHAMAS">Commonwealth of the Bahamas</option> <option value="COMOROS">Comoros</option> <option value="COOK ISLANDS">Cook Islands</option> <option value="CUBA">Cuba</option> <option value="CURACAO">Curacao</option> <option value="CZECH REPUBLIC">Czech Republic</option> <option value="DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA">Democratic People's Republic of Korea</option> <option value="CONGO, DEM REP">Democratic Republic of the Congo</option> <option value="TIMOR-LESTE">Democratic Republic of Timor-Leste</option> <option value="DOMINICAN REPUBLIC">Dominican Republic</option> <option value="URUGUAY">Eastern Republic of Uruguay</option> <option value="ECUADOR">Ecuador</option> <option value="ERITREA">Eritrea</option> <option value="ETHIOPIA">Ethopia</option> <option value="GERMANY">Federal Republic of Germany</option> <option value="NIGERIA">Federal Republic of Nigeria</option> <option value="FEDERATED STATES OF MICRONESIA">Federated States of Micronesia</option> <option value="BRAZIL">Federative Republic of Brazil</option> <option value="MACEDONIA">Former Yugoslav Republic of Macedonia</option> <option value="REUNION">French Department of Reunion</option> <option value="FRENCH POLYNESIA">French Polynesia</option> <option value="FRANCE">French Republic</option> <option value="GABON">Gabonese Republic</option> <option value="GEORGIA">Georgia</option> <option value="GHANA">Ghana</option> <option value="GIBRALTAR">Gibraltar</option> <option value="LUXEMBOURG">Grand Duchy of Luxembourg</option> <option value="LIBYA">Great Socialist People's Libyan Arab Jamahiriya</option> <option value="GREENLAND">Greenland </option> <option value="GRENADA">Grenada</option> <option value="GUYANA">Guyana</option> <option value="JORDAN">Hashemite Kingdom of Jordan</option> <option value="GREECE">Hellenic Republic</option> <option value="HONG KONG">Hong Kong</option> <option value="SAMOA">Independent State of Samoa</option> <option value="IRELAND">Ireland</option> <option value="IRAN">Islamic Republic of Iran</option> <option value="MAURITANIA">Islamic Republic of Mauritania</option> <option value="PAKISTAN">Islamic Republic of Pakistan</option> <option value="AFGHANISTAN">Islamic State of Afghanistan</option> <option value="ITALY">Italian Republic</option> <option value="JAMAICA">Jamaica</option> <option value="JAPAN">Japan</option> <option value="BELGIUM">Kingdom of Belgium</option> <option value="BHUTAN">Kingdom of Bhuran</option> <option value="CAMBODIA">Kingdom of Cambodia</option> <option value="DENMARK">Kingdom of Denmark</option> <option value="LESOTHO">Kingdom of Lesotho</option> <option value="MOROCCO">Kingdom of Morocco</option> <option value="NORWAY">Kingdom of Norway</option> <option value="SAUDI ARABIA">Kingdom of Saudi Arabia</option> <option value="SPAIN">Kingdom of Spain</option> <option value="SWAZILAND">Kingdom of Swaziland</option> <option value="SWEDEN">Kingdom of Sweden</option> <option value="THAILAND">Kingdom of Thailand</option> <option value="NETHERLANDS">Kingdom of the Netherlands</option> <option value="TONGA">Kingdom of Tonga</option> <option value="KYRGYZSTAN">Kyrgyz Republic</option> <option value="LAOS">Lao People's Democratic Republic</option> <option value="LEBANON">Lebanon</option> <option value="MACAU">Macau</option> <option value="MALAWI">Malawi</option> <option value="MALAYSIA">Malaysia</option> <option value="MALTA">Malta</option> <option value="MONGOLIA">Mongolia</option> <option value="BRUNEI">Negara Brunei Darussalam</option> <option value="NEPAL">Nepal</option> <option value="NEW CALEDONIA">New Caledonia</option> <option value="NEW ZEALAND">New Zealand</option> <option value="NICARAGUA">Nicaragua</option> <option value="NIUE">Niue</option> <option value="PAPUA NEW GUINEA">Papua New Guinea</option> <option value="ALGERIA">People's Democratic Republic of Algeria</option> <option value="BANGLADESH">People's Republic of Bangladesh</option> <option value="CHINA">People's Republic of China</option> <option value="PORTUGAL">Portuguese Republic</option> <option value="ANDORRA">Principality of Andorra</option> <option value="LIECHTENSTEIN">Principality of Liechtenstein</option> <option value="MONACO">Principality of Monaco</option> <option value="ALBANIA">Republic of Albania</option> <option value="ANGOLA">Republic of Angola</option> <option value="ARMENIA">Republic of Armenia</option> <option value="AUSTRIA">Republic of Austria</option> <option value="BELARUS">Republic of Belarus</option> <option value="BENIN">Republic of Benin</option> <option value="BOLIVIA">Republic of Bolivia</option> <option value="BOTSWANA">Republic of Botswana</option> <option value="BULGARIA">Republic of Bulgaria</option> <option value="BURUNDI">Republic of Burundi</option> <option value="CABO VERDE">Republic of Cabo Verde</option> <option value="CAMEROON">Republic of Cameroon</option> <option value="CHAD">Republic of Chad</option> <option value="CHILE">Republic of Chile</option> <option value="TAIWAN">Republic of China</option> <option value="COLOMBIA">Republic of Colombia</option> <option value="COSTA RICA">Republic of Costa Rica</option> <option value="COTE D'IVOIRE">Republic of Côte d'Ivoire</option> <option value="CROATIA">Republic of Croatia</option> <option value="CYPRUS">Republic of Cyprus</option> <option value="DJIBOUTI">Republic of Djibouti</option> <option value="EL SALVADOR">Republic of El Salvador</option> <option value="EQUATORIAL GUINEA">Republic of Equatorial Guinea</option> <option value="ESTONIA">Republic of Estonia</option> <option value="FIJI">Republic of Fiji</option> <option value="FINLAND">Republic of Finland</option> <option value="GUATEMALA">Republic of Guatemala</option> <option value="GUINEA">Republic of Guinea</option> <option value="GUINEA-BISSAU">Republic of Guinea-Bissau</option> <option value="HAITI">Republic of Haiti</option> <option value="HONDURAS">Republic of Honduras</option> <option value="HUNGARY">Republic of Hungary</option> <option value="ICELAND">Republic of Iceland</option> <option value="INDIA">Republic of India</option> <option value="INDONESIA">Republic of Indonesia</option> <option value="IRAQ">Republic of Iraq</option> <option value="KAZAKHSTAN">Republic of Kazakhstan</option> <option value="KENYA">Republic of Kenya</option> <option value="KIRIBATI">Republic of Kiribati</option> <option value="REPUBLIC OF KOREA">Republic of Korea</option> <option value="KOSOVO">Republic of Kosovo</option> <option value="LATVIA">Republic of Latvia</option> <option value="LIBERIA">Republic of Liberia</option> <option value="LITHUANIA">Republic of Lithuania</option> <option value="MADAGASCAR">Republic of Madagascar</option> <option value="MALDIVES">Republic of Maldives</option> <option value="MALI">Republic of Mali</option> <option value="MAURITIUS">Republic of Mauritius</option> <option value="MOLDOVA">Republic of Moldova</option> <option value="MONTENEGRO">Republic of Montenegro</option> <option value="MOZAMBIQUE">Republic of Mozambique</option> <option value="NAMIBIA">Republic of Namibia</option> <option value="NAURU">Republic of Nauru</option> <option value="PALAU">Republic of Palau</option> <option value="PANAMA">Republic of Panama</option> <option value="PARAGUAY">Republic of Paraguay</option> <option value="PERU">Republic of Peru</option> <option value="POLAND">Republic of Poland</option> <option value="SENEGAL">Republic of Senegal</option> <option value="SERBIA">Republic of Serbia</option> <option value="SEYCHELLES">Republic of Seychelles</option> <option value="SINGAPORE">Republic of Singapore</option> <option value="SLOVENIA">Republic of Slovenia</option> <option value="SOUTH AFRICA">Republic of South Africa</option> <option value="SOUTH SUDAN">Republic of South Sudan</option> <option value="SURINAME">Republic of Suriname</option> <option value="CONGO">Republic of the Congo</option> <option value="GAMBIA">Republic of the Gambia</option> <option value="MARSHALL ISLANDS">Republic of the Marshall Islands</option> <option value="NIGER">Republic of the Niger</option> <option value="PHILIPPINES">Republic of the Philippines</option> <option value="SUDAN">Republic of the Sudan</option> <option value="MYANMAR">Republic of the Union of Myanmar</option> <option value="UGANDA">Republic of Uganda</option> <option value="UZBEKISTAN">Republic of Uzbekistan</option> <option value="VANUATU">Republic of Vanuatu</option> <option value="YEMEN">Republic of Yemen</option> <option value="ZAMBIA">Republic of Zambia</option> <option value="ZIMBABWE">Republic of Zimbabwe</option> <option value="ROMANIA">Romania</option> <option value="RUSSIA">Russian Federation</option> <option value="RWANDA">Rwandese Republic</option> <option value="SAINT HELENA">Saint Helena</option> <option value="SAINT LUCIA">Saint Lucia</option> <option value="SAINT VINCENT AND THE GRENADINES">Saint Vincent and the Grenadines</option> <option value="SAO TOME AND PRINCIPE">Sao Tome and Principe</option> <option value="SIERRA LEONE">Sierra Leone</option> <option value="SINT MAARTEN">Sint Maarten</option> <option value="SLOVAKIA">Slovak Republic</option> <option value="VIETNAM">Socialist Republic of Vietnam</option> <option value="SOLOMON ISLANDS">Solomon Islands</option> <option value="SOMALIA">Somali Democratic Republic</option> <option value="SRI LANKA">Sri Lanka</option> <option value="BAHRAIN">State of Bahrain</option> <option value="ISRAEL">State of Israel</option> <option value="KUWAIT">State of Kuwait</option> <option value="QATAR">State of Qatar</option> <option value="OMAN">Sultanate of Oman</option> <option value="SWITZERLAND">Swiss Confederation</option> <option value="SYRIA">Syrian Arab Republic</option> <option value="TAJIKISTAN">Tajikistan</option> <option value="HOLY SEE (VATICAN CITY)">The Holy See (Vatican City State)</option> <option value="TOGO">Togolese Republic</option> <option value="TOKELAU">Tokelau</option> <option value="TRINIDAD AND TOBAGO">Trinidad and Tobago</option> <option value="TUNISIA">Tunisia</option> <option value="TURKEY">Turkey</option> <option value="TURKMENISTAN">Turkmenistan</option> <option value="TUVALU">Tuvalu</option> <option value="UKRAINE">Ukraine</option> <option value="UNITED ARAB EMIRATES">United Arab Emirates</option> <option value="UNITED KINGDOM">United Kingdom of Great Britain and Northern Ireland</option> <option value="MEXICO">United Mexican States</option> <option value="TANZANIA">United Republic of Tanzania</option> <option value="UNITED STATES">United States of America</option> </select> </div> <div class="form-group"> <label class="control-label" for="ContactZip">Zip Code/Postal Code:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Zip Code/Postal Code: must be a string or array type with a maximum length of '20'." data-val-maxlength-max="20" id="ContactZip" maxlength="20" name="ContactZip" value="" /> </div> <div class="form-group"> <label class="control-label" for="ContactPhone">Phone:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Phone: must be a string or array type with a maximum length of '50'." data-val-maxlength-max="50" id="ContactPhone" maxlength="50" name="ContactPhone" value="" /> </div> <div class="form-group"> <label class="control-label" for="ContactFax">Fax:</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Fax: must be a string or array type with a maximum length of '50'." data-val-maxlength-max="50" id="ContactFax" maxlength="50" name="ContactFax" value="" /> </div> <div class="form-group"> <label class="control-label" for="ContactEmail">E-mail *:</label> <input class="form-control" type="email" data-val="true" data-val-email="Please provide a valid email address." data-val-maxlength="The field E-mail *: must be a string or array type with a maximum length of '50'." data-val-maxlength-max="50" data-val-required="Email is required." id="ContactEmail" maxlength="50" name="ContactEmail" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="ContactEmail" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="ConferenceChairman">Conference Chairman (if different)</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field Conference Chairman (if different) must be a string or array type with a maximum length of '50'." data-val-maxlength-max="50" id="ConferenceChairman" maxlength="50" name="ConferenceChairman" value="" /> </div> <div class="form-group"> <label class="control-label" for="ProgramChairs">List program committee chairs/members with affiliation (The Optica Meetings Council recommends at a committee of at least 15 members from diverse institutions and countries to increase exposure for the meeting.) *</label> <textarea class="form-control" cols="75" rows="2" data-val="true" data-val-required="List program committee chairs/members with affiliation is required." id="ProgramChairs" name="ProgramChairs"> </textarea> <span class="text-danger field-validation-valid" data-valmsg-for="ProgramChairs" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="EndorsementCriteria">As endorsement criteria, we request that you include a designated Optica member to serve on your meeting’s program committee. Please suggest an Optica Representative that will serve in this capacity: *</label> <input class="form-control" type="text" data-val="true" data-val-maxlength="The field As endorsement criteria, we request that you include a designated Optica member to serve on your meeting’s program committee. Please suggest an Optica Representative that will serve in this capacity: * must be a string or array type with a maximum length of '100'." data-val-maxlength-max="100" data-val-required="As endorsement criteria is required." id="EndorsementCriteria" maxlength="100" name="EndorsementCriteria" value="" /> <span class="text-danger field-validation-valid" data-valmsg-for="EndorsementCriteria" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="InvitedSpeakers">List invited speakers with affiliation, please note which speakers have been confirmed *</label> <textarea class="form-control" cols="75" rows="2" data-val="true" data-val-required="List invited speakers with affiliation is required." id="InvitedSpeakers" name="InvitedSpeakers"> </textarea> <span class="text-danger field-validation-valid" data-valmsg-for="InvitedSpeakers" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="OtherSocieties">List other societies co-sponsoring or cooperating on this meeting, if any. Please note which have been confirmed and which have been invited.</label> <textarea class="form-control" cols="75" rows="2" id="OtherSocieties" name="OtherSocieties"> </textarea> </div> <div class="form-group"> <label class="control-label" for="MeetingScope">List meeting scope (topics) to be covered *</label> <textarea class="form-control" cols="75" rows="2" data-val="true" data-val-required="List meeting scope to be covered is required." id="MeetingScope" name="MeetingScope"> </textarea> <span class="text-danger field-validation-valid" data-valmsg-for="MeetingScope" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="PlanToIncludePeople">Please explain how you plan to include people of diverse cultures, backgrounds, and experiences. *</label> <textarea class="form-control" cols="75" rows="2" data-val="true" data-val-required="Please explain how you plan to include people of diverse cultures, backgrounds, and experiences is required." id="PlanToIncludePeople" name="PlanToIncludePeople"> </textarea> <span class="text-danger field-validation-valid" data-valmsg-for="PlanToIncludePeople" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="ConferenceSeries">Is this conference one in a series of conferences? *</label> <label><input value="true" type="radio" checked="checked" data-val="true" data-val-required="Conference one in a series of conferences is required." id="ConferenceSeries" name="ConferenceSeries" />Yes</label> <label><input value="false" type="radio" id="ConferenceSeries" name="ConferenceSeries" />No</label> <span class="text-danger field-validation-valid" data-valmsg-for="ConferenceSeries" data-valmsg-replace="true"></span> </div> <div class="form-group"> <div>If so, please attach a final report and attendee list from the previous meeting (.pdf, .doc, .docx, .xls, .xlsx and .zip files are accepted)</div> <input type="file" id="ConferenceSeriesFile" name="ConferenceSeriesFile" /> <span class="text-danger field-validation-valid" data-valmsg-for="ConferenceSeriesFile" data-valmsg-replace="true"></span> <span class="text-danger" id="msgFileUploaded"></span> <input type="hidden" data-val="true" data-val-fileextensions="Only Pdf, Doc, Docx, Xls, Xlsx and Zip files are accepted." data-val-fileextensions-extensions=".pdf,.doc,.docx,.xls,.xlsx,.zip" id="ConferenceSeriesFileName" name="ConferenceSeriesFileName" value="" /> </div> <div class="form-group"> <label class="control-label" for="OsaSupported">Has Optica supported this conference before? *</label> <label><input value="true" type="radio" checked="checked" data-val="true" data-val-required="Optica supported this conference before is required." id="OsaSupported" name="OsaSupported" />Yes</label> <label><input value="false" type="radio" id="OsaSupported" name="OsaSupported" />No</label> <span class="text-danger field-validation-valid" data-valmsg-for="OsaSupported" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="SupportDescription">If so, list the type of support (financial or endorsement only)</label> <textarea class="form-control" cols="75" rows="2" id="SupportDescription" name="SupportDescription"> </textarea> </div> <div class="form-group"> <label class="control-label" for="OsaSupportedOtherEvents">Has Optica supported other conferences organized by the same institution and essentially similar organizing committee? *</label> <label><input value="true" type="radio" checked="checked" data-val="true" data-val-required="Optica supported other conferences is required." id="OsaSupportedOtherEvents" name="OsaSupportedOtherEvents" />Yes</label> <label><input value="false" type="radio" id="OsaSupportedOtherEvents" name="OsaSupportedOtherEvents" />No</label> <span class="text-danger field-validation-valid" data-valmsg-for="OsaSupportedOtherEvents" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label" for="SupportDescriptionOther">If so, list the type of support (financial or endorsement only)</label> <textarea class="form-control" cols="75" rows="2" id="SupportDescriptionOther" name="SupportDescriptionOther"> </textarea> </div> <div class="form-group"><br/> The next (and final) page will ask you to identify the technical groups that are relevant to the scope of your meeting. If you would like more information before proceeding, go to the <a href="https://www.osa.org/en-us/get_involved/technical_groups" target="_blank">Technical Groups</a> page, for a listing and scope of each. In addition, you will be asked to confirm the type of support you are requesting. 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