Institute for Mathematics and its Applications

IMA Tutorial/Workshop: Composites: Where Mathematics Meets Industry Registration Form

Participation in this IMA tutorial/workshop requires you to register. To request an invitation to an IMA workshop or other program, complete this form and press the submit button at the bottom of the form. Fields labeled in red are required.

Please note:

Registration deadline is Jan. 20, 2005 if you are presenting a problem. Otherwise, the registration deadline is Jan. 31, 2005.

IMA workshops are generally directed towards scientists possessing a doctoral degree and actively involved in the topic of the workshop.

Housing requests and modifications need to be made 10 business days prior to arrival date.

REGISTRANT INFORMATION

Full Name:  
Position: university faculty  postdoctoral researcher graduate student
              industrial scientist government scientist
              other (explain) 

Organization: 
Department: 
Full address (including postal or zip code and country):
   
E-mail:  
Phone: 
Fax:  

Highest educational degree: 
Field:   Year awarded:   
Institution awarding that degree: 

Gender:   Female     Male     Do not wish to provide

Race/Ethnic:   White     Black     Asian/Pacific Islander     American Indian/Native American
                          Hispanic     Other     Do not wish to provide

Citizenship(for visa purposes):   

Referred by:

PROBLEM PRESENTATION FEE

I am not presenting a problem
I am from an IMA Participating Corporation where the $1,000 fee will be waived
I am from an IMA non-Participating Corporation and will be charged the $1,000 Presentation Fee. Please go to "Make a Gift to the IMA" web page at http://www.ima.umn.edu/gift

If you wish to present a problem, enter the problem description below:

REQUESTED PERIOD OF STAY

The stay should normally coincide with the workshop dates plus reasonable travel arrangements.

Arrival Date: Departure Date:

SUPPORTING INFORMATION

If not clear from your position, please explain your background and interest in the program. Your curriculum vitae or other information may be requested if further information is needed. Graduate students should also request a statement of support for their participation from their advisor, to be sent by email to associate@ima.umn.edu . If requesting an extended stay, explain here.

Thank you for your interest in IMA Programs.