Texas Geometry and Topology Conference
Registration Form

To register for the Fall 2003 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		 Number of people 
attending banquet on Saturday
Dietary restrictions:

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

The dinner on Friday evening is free but there will be a charge for the banquet Saturday evening. 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. Participants will be housed at the Residence Inn or the Best Western, and reservations will be made directly by the Mathematics Department. We will cover other travel expenses if there are sufficient funds.   

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.