Registration Form

All participants are requested to register for the 2012 Southwest Local Algebra Meeting hosted by the
Department of Mathematics and Statistics at Texas Tech University. Please do so by filling in and submitting this form.

Contact Information
First Name		Last Name
Institution
Street Address
Address (cont.)
City		State/Province
Zip Code		Country
Phone Number		E-mail

Status
Tenured Faculty	Untenured Faculty	Graduate Student	Other:
Will you be presenting a poster?		Yes No
Title:

Saturday Night Party The party takes place at the home of Professor P.D. Mara Neusel; food and drink will be provided. Please let us know:
Will you attend the party?	Yes No
Are you vegetarian?	Yes No
Number in your party?

Hotel To reserve a room at the Overton Hotel at the conference rate of $85 plus tax, you must fill in this section.
Arrival date and time	Departure date
Are you willing to share a room?	Yes No
Preferred roommate:

Support
Do you wish to be considered for support?	Yes No
Please tell us about requests for special accommodations or any other comments: