DIMACS Workshop Registration Form

DIMACS/MBI US - African BioMathematics Initiative:
Workshop on Quantitative Landscape Ecology and Environmental Sustainability
University of KwaZulu-Natal, Durban, South Africa

July 3 - 7, 2012

Please register by filling out the following blanks.

When finished and you have checked the correctness of information, press the "send" button at the bottom of the form.

Attendance is limited to available space; please register early.

Fees include lunch and breaks. Partial support for registration fees might be available. Please contact Eugene Fiorini (usai (at) dimacs.rutgers.edu) to inquire.

       

  Dates you plan to Attend: 

           Your First Name: 
          Your Middle Name: 
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             Your Position: 


Your Postal Address: (This information will be used for nametags & mailing lists)
      Name of organization: 
                            (University or Company Name)


         Organization Type:  
                Department: 
            Street Address: 
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Comments: (i.e. dietary restrictions)

Please contact the organizer(s) directly if you would like to submit a paper or poster.

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