Moonshine Workshop Registration Form

Moonshine - the First Quarter Century and Beyond.

Scientific Programme | Workshop Arrangements | Workshop Home Page | Registration Form

	Registration Form All participants should complete Sections 1 to 3. Those applying for financial support should complete Section 4
Section 1	Personal Details
Last Name
First Name
Title
Email
Institution
Department and Institution's Address
Telephone
Special requirements	Please specify any special dietary or other requirements
Section 2	Dates of Attendance
	I expect to arrive on (day of the week) (date i.e. dd/mm/yy) and leave on (day of the week) (date i.e. dd/mm/yy) .
Section 3	Financial Information Please choose one of the following options:
	I will pay by cheque or banker's draft in sterling. I will pay by credit card (add 1.75%)
Section 4	Request for Financial Support You may request support only if you are either (a) a PhD student at a UK HEI or (b) if you are employed in a mathematical department in a UK HEI. Please choose one of the following options:.
	I am a PhD student in a UK HEI and wish to apply for a £200 discount on my Registration Fee (I understand that £45 remains payable by me) and up to £200 reimbursement against receipts for my accommodation and/or travel. I employed in a UK HEI and wish to apply for a £200 discount on my Registration Fee (I understand that £45 remains payable by me).

Scientific Programme | Workshop Arrangements | Workshop Home Page | Registration Form