Please send a copy of this form to Zhongwei Shen

Department of Mathematics

University of Kentucky

Lexington, KY 40506

The 49^th Midwest PDE Seminar Registration Form

Last Name: First Name:

Full mailing address:

Line One:

Line Two:

City: State: Zip:

Tel: E-mail:

Current institution or organization:

Please indicate if you plan to attend the conference banquet

on Saturday, March 16, 2002 (approximately $15 per person):

Yes/No:

Funds are available to support participants. Priority will be given to students and recent Ph.Ds as well as underrepresented groups of researchers. Participants from participating institutions of the IMA may obtain financial support from their PI funds.

If you would like to request financial support to attend the conference, please fill out the following (we will begin considering applications on February 1, 2002, but later applications will be considered till the money runs out).

Year of Ph.D:

Institution and Advisor:

Estimated travel and local expenses: