Registration Form

All participants are requested to register for the 2018 Southwest Local Algebra Meeting hosted by the
Department of Mathematical Sciences at University of Arkansas. 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

Employment

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

Saturday Night Party

The party takes place right after the talks on Saturday; 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 secure a room at the conference hotel, you must fill in this section; we make the reservation.

Arrival date Departure date
Are you willing to share a room? (Graduate students must share to be supported.) Yes     No
Preferred roommate:

Reporting Information

We collect the following information for the purpose of reporting to the funding agencies.

Gender Male     Female
Prefer not to say
Ethnicity/Race Asian
American Indian or Alaskan Native
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Two or more races
Prefer not to say
US Citizen or Permanent Resident Yes     No

Support

Do you wish to be considered for support? Yes     No

Please tell us about requests for special accommodations or any other comments: