DIMACS Workshop Registration Form



                    DIMACS Workshop Registration Form
              2nd Conference for African-American Researchers 
	          in the Mathematical Sciences (CAARMS)
			    June 26-28, 1996

     
The registration fee is $40 through June 20 or $50 afterwards.

Please enclose fee and make check payable to RUTGERS.

Name:  .............................................................

Job Title:  ................................ Student?  .............

Address:  ..........................................................

....................................................................

....................................................................

Phone:  ............................................................

Fax:  ..............................................................

Email:  ............................................................

Number of nights you will be staying: 4? ..... 5? ..... Other? .....

Do you wish to share a room with another participant (Y/N)? ........

If yes, list name of participant below (or one will be assigned):

....................................................................

Are you planning to drive to the conference (Y/N)? .................

If  yes, please list your license plate number to obtain  a  Rutgers 

parking sticker (no charge) ........................................

The  conference has limited funds to reimburse invited speakers  and
poster presenters. We can also provide partial support for a limited
number of participants.

Are you requesting financial assistance (Y/N)? .....................

Other special needs: ...............................................

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Document last modified on November 2, 1998.