Texas Geometry and Topology Conference
Registration Form

To register for the Fall 2006 Texas Geometry and Topology Conference, please complete this form:

Last Name: First Name:
Home Institution:
Address Line 1:
Address Line 2:
City: State:  Zip: 
Work Phone: Home Phone:
Complete E-mail Address: Fax:
Number of people attending...
...dinner on Friday
...Saturday evening restaurant excursion
Dietary restrictions:

Comments:

Do you wish to apply for support?		 No 
  Yes    If yes, continue below.

The dinner on Friday evening is free but you will have to pay for your meal at the Saturday evening excursion. We anticipate being able to provide some travel support for graduate students and postdocs participating in the conference. We will accomodate requests from regular faculty if there are sufficient funds. Early requests will be given preference. Our first priority is to provide lodging. Funded participants will be housed with another participant at the Marriot Medical Center and reservations will be made directly by the Mathematics Department. We will cover other travel expenses if there are sufficient funds. To receive support, you must register by October 2nd.   

Application for financial support
SSN#:             Gender: Female Male 
Position: Senior Faculty Junior Faculty Grad Student Other: 
Arrival date: Earlier Fri Sat AM Sat PM 
Departure date: Sat AM Sat PM Sun Later
Preferred roomate if desired (optional):
Estimated expenses: Airfare: $     Gas: $     Lodging: $     Car/Taxi: $
Citizen Info: US
  Permanent Resident  Alien #: 
  Non US Country:  Visa Type: 

For reimbursements turn in all receipts to Marie Magee.