Sixth Mississippi State - UAB Conference

on Differential Equations & Computational Simulations
Conference Registration

Please do not use dashes "-" when you fill the form

Name:

Mailing Address:

Organization:

Phone:

FAX:

Email

Meal Preference

	FEES

Pre-Registration (Deadline: May 1, 2005):	$100.00
On site:	$120.00

These fees are primarily to offset the costs of some of the supplies, local transportation and a conference T-Shirt. Also continental breakfasts, lunches and dinners will be provided on May 13th & 14th.
You have finished pre-registering if you have filled out the above form and if you have sent your payment. Pre-registration deadline is May 1, 2005. Please make checks payable to the Diff. Eq. Conference (we DO NOT accept credit cards). Your payment must be sent to:

Chuanxi Qian
Department of Mathematics and Statistics
Mississippi State University
Mississippi State, MS 39762,U.S.A.