Workshop Registration Form
Registration deadline: April 15, 2001
Name_______________________________________________________________________
First Middle Initial Last
Address______________________________________________________________________
City_______________________________________State________Zip____________________
Telephone_____________________________________________________________________
Fax__________________________________________________________________________
E-mail ________________________________________________________________________
Please circle only one of the registration fees below:
Regular: $50.00
Student: $10.00
Registration fee includes lunches and refreshments
Total Registration Fee ____________
I am a speaker in (circle): Minisymposium Contributed
Name Badge Information:
I prefer my name and affiliation to read as follows:
Name (20 Characters)______________________________________________
Affiliation (20 characters)___________________________________________
Payment Information:
Please make checks payable to "University of Houston" and mail registration form with fee by April 15 to
Professor Tsorng-Whay Pan
Department of Mathematics
University of Houston
Houston, TX 77204-3476
MII 2001 Southwest Home