--------------------------------------------------------------------- 2001 ILLINOIS NUMBER THEORY CONFERENCE --------------------------------------------------------------------- May 18-19, 2001 REGISTRATION FORM To register for the conference, please print out a hard copy of this form and mail the completed form to the following address: Illinois Number Theory Conference 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. (Graduate students and recent PhD's who qualify for support - see below - are exempt from the prepayment requirement.) 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/nt2001/. ---------------------------------------------------------------- REGISTRATION INFORMATION: ---------------------------------------------------------------- Name: Institution: Email: If you are interested in staying over for the Workshop on the Interface of Probability and Number Theory, to be held for Sunday, May 20, please check here: ___ ---------------------------------------------------------------- FINANCIAL SUPPORT: ---------------------------------------------------------------- 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 support (e.g., NSF grants, or departmental funds) Institution: For supported participants we will cover the costs of dormitory accommodation, one banquet ticket, and pay a per diem rate to cover meal costs. It is uncertain if, and to what extent, we can contribute towards travel costs (plane tickets, etc.); we therefore ask that you try to obtain such support from other sources such as your own department. If we have sufficient funds left over after the conference, we may be able to provide partial reimbursement of travel expenses for those who do not have access to other sources of funding. If you expect to need such support, please indicate so below. NOTES: ---------------------------------------------------------------- TALKS: ---------------------------------------------------------------- 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, 2001. Title of talk: Abstract (2 or 3 sentences, in plain text or TeX): ---------------------------------------------------------------- DORMITORY ROOM RESERVATION: ---------------------------------------------------------------- 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 17 ___ May 18 ___ May 19 Rooms are $22 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, 2001. [For other accommodation options, see the conference web page, http://www.math.uiuc.edu/~hildebr/nt2001/.] ---------------------------------------------------------------- BANQUET RESERVATION: ---------------------------------------------------------------- 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: ___ ---------------------------------------------------------------- TOTAL COST: ---------------------------------------------------------------- Dormitory room at Hendrick House ($22 per night): ___ Banquet tickets ($20 per ticket): ___ ----------------------------------------------------- Total: ____ Please enclose this amount, in the form of a check, made out to the "University of Illinois". (Our mailing address is given on the top of this form. No payment is necessary if you qualify for financial support) A full refund will be given for cancellations received by April 20; we will not cash your check until after the cancellation deadline. ---------------------------------------------------------------- REMARKS: ----------------------------------------------------------------