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           2002 ILLINOIS NUMBER THEORY CONFERENCE
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                    May 17-18, 2002 

                    REGISTRATION FORM

To register for the conference, please fill out and return this form to
ajh@uiuc.edu, and/or send a hard copy to the following address:

      A.J. Hildebrand
      University of Illinois 
      Department of Mathematics
      1409 West Green St.
      Urbana, IL 61801 

There is no registration fee, but if you wish to reserve a room at
Hendrick House and/or a banquet ticket, please enclose a check, made
out to the University of Illinois, for the appropriate amount.  
(No payment is necessary if you qualify for financial support - see 
below.) 

DEADLINE:  Room and banquet ticket reservations, and requests for
contributed talks must be received by April 20.

For more information about the conference, please visit the conference
web page, http://www.math.uiuc.edu/~hildebr/nt02/.



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REGISTRATION INFORMATION:
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Name:

Institution:

Email:



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FINANCIAL SUPPORT:
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Support is available for participants in the following categories: (i)
graduate students, and (ii) recent PhDs who do not have other means of
support.  Due to funding restrictions, this support is restricted to
U.S. residents.  To apply for support, please check the appropriate
category and fill out the requested information.

__ Graduate Student
   Institution: 
   Name and email address of thesis advisor or other faculty member
   familiar  with your academic work:


__ Postdoc/recent PhD (defined as any untenured faculty) without
   other sources of support (e.g., NSF Grant)
   Institution:

For supported participants we will cover all local expenses (3 nights at
Hendrick House, meals and one banquet ticket), and we may be able 
to contribute towards travel costs.  We ask, however, that other
sources of support be exhausted first.  If you expect to need such
support, please give details here.

NOTES:




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TALKS:
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If you are interested in giving a 20 minute talk, please provide a
title and an abstract.  Note that the space for contributed talks
is limited, and we may not be able to accommodate all requests for
talks.  The deadline for requesting a slot for a contributed talk
is April 20, 2002.

Title of talk:




Abstract (2 or 3 sentences, in plain text or TeX):














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DORMITORY ROOM RESERVATION:
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Reservations for dormitory accommodation at Hendrick House must be made
through us.  If you wish to reserve a room, please check the nights on
which you need a room. 

__ May 16     ___ May 17     ___ May 18 

Rooms are $20 per night, and the appropriate amount must be enclosed
with the registration form, unless you qualify for support (see above).  
The deadline for room reservations at Hendrick House is April 20, 2002.

[For other accommodation options, see the conference web page, 
http://www.math.uiuc.edu/~hildebr/nt02/.]


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BANQUET RESERVATION:
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The conference banquet will be held Friday evening. Banquet tickets
are $20 each; a vegetarian option will be offered.

Number of banquet tickets: ___   Total cost ($20 per ticket): ___ 

Check here if you would like the vegetarian option: ___


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TOTAL COST:
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Dormitory room at Hendrick House ($20 per night): ___

Banquet tickets ($20 per ticket):   ___

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Total: ____

Please enclose this amount, in the form of a check, made out to the
"University of Illinois".  (No payment is necessary if you qualify
for financial support, as indicated above.) 

The deadline for all reservations, and requests for talks  is April 20,
2002.

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REMARKS: 
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