Short Course 2001 Registration Form

WNEC and NES/MAA Short Course on ILAP's --June 17 - 20, 2001
Registration/Application Form

On-line registration is not available. Please mail this form early (deadline May 16) as enrollment is limited.Mail to:

Dennis M. Luciano, Chair

Department of Mathematics and Computer Science

Western New England College

Springfield, MA 01119

email: dluciano@wnec.eduTelephone: (413) 782-1275

Acknowledgements will be mailed immediately.Acceptances with full instructions and details will be mailed by June 1.

A minimum $75 deposit will be required within 7 days of acceptance.Do not send money with this application.You will be billed when you are accepted.

Name: _______________________________________________________

Address: ____________________________________________________

____________________________________________________________

City: ____________________________State: _______Zip: __________

Institution: ___________________________________________________

Telephone:______________________e-mail: ___________________________

If you are part of an interdisciplinary team, list other members:_______________

_________________________________________________________________

Indicate Discipline(s) in which you would like to explore applications: ________

_______________________________________________________________

Registration, Room, and Board

$250 for Single Occupancy ______________

$220 for Double Occupancy ______________

Registration, Lunches, Reception and

following Dinner - $110 ______________

E-mail about webpage: gingrich@scsu.ctstateu.edu
URL: http://scsu.ctstateu.edu/~maa_nes/shortcourse2001regform.html
Revised: May 2, 2001

"The views and opinions expressed in this page are strictly those of the page author and have not been reviewed or approved by Southern Connecticut State University."