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Geometric Topology in 3 and 4 Dimensions

Registration and Travel Support

If you are planning on attending the conference, please let us know by copying the following form into an e-mail, filling it out and sending it to mtomova@math.uiowa.edu. The deadline for funding is April 24, 2009.

Last name:

First name:

e-mail address:

University affiliation:

Do you want to be considered for support? Yes / No (If you choose No, you can skip the following questions and send the form in now.)

What is your citizenship status (choose one of the following)? US Citizen / Resident Alien / Nonresident Alien.

Which of the following apply to you?

I received my Ph.D. within the last 5 years. Yes / No

I am a woman or a member of an underrepresented minority. Yes / No

I am a graduate student. Yes / No

If you are a graduate student, could you tell us a little bit about yourself? (E.g., I am an nth year student working with Prof X on Y.)

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