Registration Form for  the
XIIth OPORTO MEETING on GEOMETRY, TOPOLOGY and PHYSICS

Please complete and submit this application form below before April 30th, 2003.
The entries marked with an asterisk (*) are optional.

If you have any problems filling this form, please send an email to crherdei@fc.up.pt.


Last name:
First name:
Affiliation:
Address:
Street:
City:   Postal Code:
Country:
Email: (name@host.domain)
Date of Birth*: (Necessary only if you are applying for financial support)
month   year   

If you are a graduate student or recent PhD please indicate your main research interests and the name of someone willing to send a recommendation letter on your behalf if needed:

Personal Web Page*: (e.g. host.domain/~username)
Fax*:

Do you wish to give a talk (please note that it may be impossible to arrange a slot for everyone due to the tight schedule)?

IF YES, PLEASE SEND US THE TITLE and a SHORT ABSTRACT (prefereably with a list of references):

Arrival and Departure:  
   The participants will be accommodated at the Hotel Ipanema Porto and Hotel Tuela, which are located a few minutes' walk from the Department.

   The standard arrival date is Wednesday, July 16 and the standard departure date is Monday, July 21.

Arrival Date:    day    month 
Departure Date:    day    month 

Accompanying person(s):

Type of accomodation (the default hotel is Hotel Ipanema Porto, where lunch will take place during the Meeting. Please indicate here in case you prefer Hotel Tuela)
(single, double, shared double)
Note: in case you choose shared double please indicate wether you are male or female and (optional) the name of the participant you would like to share the room with 
If you require full or partial financial support in order to attend, please explain our situation. (please note however that due to our very tight budget it is quite likely that no such support will be available):

 

March, 2003