Application Form

To apply for the 1996 NSF/CBMS Conference hosted by the Department of Mathematics Texas Tech University, please complete and submit this form.


    Last Name:     First Name:

SS#:

Address:

City: State: Zip:

Work Ph. Home Ph.

E-mail Address Fax

Please check the appropriate boxes below:

Graduate Student

I have arranged for a letter of support from my advisor

(name) (institution) Faculty Member

I will be mailing a short vita.

I require the following special accomodations

I require a special diet (ie., vegetarian, kosher, etc.)

please specify:

Requests for support: I would like support for travel and housing I would like support for housing only I would like support for travel only I will be attending, but will not need support Briefly describe your research interests relevant to this conference.

Women and minorities are encouraged to apply.

Consideration of applications will begin on April 2, 1996

To submit the form, press: