DIMACS Workshop Registration Form

               76th STATISTICAL MECHANICS CONFERENCE
              RUTGERS UNIVERSITY, HILL CENTER, ROOM 114
      SUNDAY, MONDAY & TUESDAY, DECEMBER 15th, 16th & 17th, 1996

                    DIMACS Workshop Registration Form
           Workshop on Computational and Physical Aspects of
                   Protein Folding and Related Problems
			 December 16 - 17, 1996 
     
                *** Please return this page only ***



NAME:______________________________AFFILIATION:________________________________


1.  I plan to attend all days[  ]; Sun.only[  ]; Mon.only[  ]; Tues.only[  ]   


2.  I DO NOT plan to attend [  ]     Do[  ]  Do not[  ]  Remove my name


MEALS:   
           Sunday   - Lunch                 $ 9.00 [  ]
           Sunday   - Cocktails & Dinner    $20.00 [  ]
           Monday   - Lunch                 $ 9.00 [  ]      
           Monday   - Cocktails &Dinner     $20.00 [  ]            
           Tuesday  - Lunch                 $ 9.00 [  ]

                                            
3.I would like to talk in Session A___ B___ (Visual Aids not available)
Title,Author(s) & Affiliation (use ***for author presenting talk)



4.I need a parking permit[   ]; additional travel information[   ]  

5.  I need reservations at Econolodge ___  Hyatt ___

    Dec. 14____    Dec. 15____    Dec. 16____    Dec. 17____    

    I do ___    I do not ___  wish to share my room

6.  I have available ___    I need ___   (type of position) 
    These will be listed in the program

    ________________________________________________________

7.  Please put the following person(s) on the EMAIL/mailing list:


    ________________________________________________________



REGISTRATION FEE:   $35.00 one day/$55.00 two days/$65 three days

The fee covers Breakfast (juice, coffee, rolls). Rutgers people,
graduate students NOT ON GRANTS, and scientists unemployed during the past
year are exempt from registration fee.



--PAA25189.845234903/fermat.rutgers.edu--


Please email this form to:
     lebowitz@math.rutgers.edu

or FAX to:
	908-445-4936

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