Application/Registration -- Opening Workshop

19 T.W. Alexander Drive
P.O.Box 14006
Research Triangle Park, NC 27709-4006
Tel: 919.685.9350
Fax: 919.685.9360
[email protected]

SAMSI Program on Stochastic Dynamics

Opening Workshop

August 30 - September 2, 2009

Workshop Application/Registration

To apply to attend the workshop or for travel support, or to register if you are an invited participant or discussion leader, please fill out the form below, and then click the SUBMIT APPLICATION/REGISTRATION button. Items in red are required. Following submission, a confirmation of your application or registration will be displayed. (Print a copy for your records.) Applicants will be notified as soon as possible if their application is approved, and should not make travel arrangements until notification is received.

Applications/registrations will be considered until the workshop capacity is reached.
No applications will be accepted after August 14, 2009.
Any application that requests support for expenses should typically be submitted at least 6 weeks in advance of the workshop.

SAMSI Travel Policy

Registration Fees

	FACULTY/PROFESSIONAL	STUDENT
ALL Events	$160.00	$80.00
Tutorials Only	$30.00	$15.00
Workshop Only	$130.00	$65.00

Fees are due upon notification of acceptance of your application. SAMSI accepts check, Visa, or MasterCard.

For Credit Card Payments:

Fill out the payment form (PDF file)
Fax it to (919) 685-9331

For Check Payments:

Fill out the payment form (PDF file)
Mail the form and check (payable to SAMSI) to:

SAMSI
Attn: Stochastic Dynamics Opening Workshop
PO Box 14006
Research Triangle Park, NC 27709-4006

In order to guarantee proper credit to your registration, SAMSI must receive payment by August 14, 2009.

Participant Information

First Name Family Name

Title

Organization

Department

Discipline

Address

City

State (Use NA if not US)

Province

Zip (or Postal) Code

Country Required if not US

Telephone

FAX

E-mail

URL

Visa Status (please select one)

US Citizen
US Permanent Resident (Green Card Holder)
Visa Holder

Interest in the Program

Please describe briefly your background and reasons for wishing to participate in the workshop.

Events to be Attended

All Events

Tutorials (Sunday, August 30, 2009)

Workshop (Monday-Wednesday, August 31 - September 2, 2009)

I will participate in initial Working Group Meetings (after the workshop - Thursday-Friday, September 3-4, 2009)

Status

Student Faculty/Professional

Poster Presentations

Check here if you wish to present a poster at the poster session, and if so provide the title.

Poster Title

Request for Financial Support

I will cover my own expenses. (Thank you for allowing our limited resources to be used for those who most need it!)

I request support for the registration fee and accommodations.

I request support for travel expenses.

Support levels will be determined by SAMSI, but will in no case exceed reimbursement for travel and housing expenses supported by proper receipts. For SAMSI's records and reports, applicants for support are requested to E-mail a brief CV or resume (the 2-page format used for NSF proposals is ideal) to [email protected]. New researchers and members of under-represented groups are especially encouraged to apply for support.

NISS Affiliates and NISS/SAMSI University Affiliates Only

Check this box if you are from a NISS Affiliate and plan to request reimbursement from your NISS/SAMSI Reimbursement Account.

Graduate Students Only

Please check the box below, and in the "special request" block, identify your advisor and dissertation topic.

I am a graduate student.

Invited Participants or Discussion Leaders Only

Check here if you are an invited participant or discussion leader.

If you are an invited speaker, please provide the title and abstract of your presentation.
If you are an invited Discussion Leader, put N/A in the Title section and the Abstract section below. This is to ensure your registration will be submitted properly.

Title

Abstract

Special Requests

If you have special requests (such as dietary restrictions or a guest for the poster session), please enter them below. Other questions should be sent by E-mail to [email protected].

Submission

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