Lehigh University International Symposium in memory of C-C Hsiung

Please submit this form, or a paper version, by May 15. If you plan to attend, please return the form even if you do not require housing, in order that we can provide a list of participants and plan for refreshments. To submit an abstract for a presentation at the poster session, see Poster Session Abstracts. We request that you submit abstracts by April 15 to be considered for the poster session.

If you wish to request travel support, you should also fill out the travel support form.



Personal Data

Name:
First
Last

Address (use up to 3 lines)


City State
Nation (If not US):

Zip , or international postal code:

Telephone Number: extension?

Email Address:


Housing Information

On-campus dormitory housing will be available at a subsidized rate All rooms are single occupancy rooms arranged in suites. To request a dorm room, please complete the following information:

Which nights do you need housing?

Thursday
Friday
Saturday
Sunday

Gender (for suite assignments)

Male
Female

If you specifically wish to share a room with another conference participant (rather than a non-participant accompanying you), please indicate that person's name:




Banquet

On Saturday evening there will be a banquet. All conference participants are invited. There is no additional charge for the banquet for participants. Guests are invited at a cost of $25. Number attending banquet:

None 1 2 More than 2


Charges

There is a $35 registration fee, which includes the banquet, and $25 per night fee for the dorm room ($35 per night per room for double occupancy).

Since we have no reasonable way to collect charges over the internet (we cannot accept PayPal), you may either send a check, payable to Lehigh University, to David Johnson or Don Davis at the address at the bottom of this form, or you may pay upon arrival (with either a check or credit card).


If you have any special needs or questions, please write them here.


Last Modified April 30, 2010 by David Johnson dlj0@lehigh.edu.

David L. Johnson or Donald M. Davis
14 E. Packer Avenue
Department of Mathematics
Lehigh University
Bethlehem, PA 18015-3174

Telephone: (610) 758-3759