Dynamics of Complex Systems WORKSHOP
FAIRBANKS, ALASKA
MAY 21 - 23, 2001
PRE-REGISTRATION FORM

- Participant:

Name (last, first, middle initial):
________________________________________

Affiliation/Institution:
________________________________________________

Address (Street, City, State, Zip, Country):
_______________________________

___________________________________________________________________

___________________________________________________________________

Phone Number: __________________________________

Fax Number: ____________________________________

E-Mail Address:__________________________________

-Meeting Registration/Activity Fee(check all that apply):

__ I do plan to attend the Complex Systems Workshop at Fairbanks, Alaska.

__ I will be accompanied by a companion.

__ My check for $50.00 made out to "Complex Systems Workshop" is enclosed. If not enclosed, the registration fee of $50.00 (checks only) will be collected on site.

- Presentation:

__ I would like to make the following presentation at the meeting:

Title:________________________________________________________
(An abstract of the proposed presentation should be enclosed or attached.)

__ I would prefer and oral presentation

-Special Needs:_____________________________________________________

___________________________________________________________________
 
 

c/o David Newman      -     FAX: (907) 474-6130

University of Alaska-Fairbanks
Physics Department
P.O. Box 755920
Fairbanks, AK 99775-5920
USA

Phone: (907) 474-7858