Registration Form
Registration for the Analysis, Complex Geometry, and Mathematical Physics Conference, May 7-11, 2013. For those requesting travel support, priority will be given to requests received before March 1, 2013. If you have any questions regarding the completion of this form, please contact the conference organizers at acgmp@math.columbia.edu.
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First name: *
Last name: *
Email address: *
Affiliation: *
Position *
What is your expected arrival date? *
mm/dd/yyyy
What is your expected departure date? *
mm/dd/yyyy
Are you planning to attend the conference banquet on Saturday evening, May 11? *
Banquet seats are limited. The banquet will be held at the Italian Academy, in the Teatro room on the second floor.
If you would like to bring additional guests to the banquet, please indicate the number of additional guests. Otherwise, please leave blank.
If you are attending banquet, do you have any dietary restrictions? If not, please leave blank.
Are you requesting partial travel support? *
If you are requesting partial travel support, please indicate your academic status: *
Please note that we can only reimburse airline tickets issued by a U.S. flag carrier. Recent Ph.D. recipients should have received their degrees no earlier than May 2007. All participants (except for invited speakers) are responsible for making their own travel arrangements such as booking flights, hotels, etc. If you indicate that you are applying for partial travel reimbursement, we will contact you after March 1, 2013.  Funds for travel are limited and we are unlikely to be able to offer support to all participants who apply or fully reimburse travel costs. If not requesting support, please select "Neither".
If you are requesting partial travel support, please tell us your field of research and, if a graduate student, the name of your Ph.D. advisor: *
If not requesting support, please enter "NA".
If you are a graduate student requesting partial travel support, please tell us your year of study: *
For example, 3rd year. If not requesting support, please enter "NA".
If you are requesting partial travel support, we would be grateful if you could please indicate your gender and/or membership in traditionally under-represented groups.
We especially encourage participation by students, postdoctoral and junior faculty researchers, women, and members of traditionally under-represented groups. Your response to this question is completely optional but information regarding the diversity of participants is valued by the conference organizers.
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