Registration Form

Personal Information
Course Preferences
Academic Sponsor (Students Only)
Application for Financial Support
Accommodation
T-Shirt
Consent
Submission of Application

To apply for the Summer School please provide the information below by 16 November 2007, the deadline for applications. Your application will be assessed and an invoice will be sent to you if the application is successful.

The registration fee will be AU$143 for students from AMSI member institutions and full time students enrolled at an institution which is a member of the Pacific Rim Mathematical Association (PRIMA), for all others it will be AU$715. Once accepted you will receive an invoice.

Personal Information

Starred fields are mandatory.

Surname*
Other Names*
Preferred Name tag
Gender*	Male Female
University/Institution*
Department*
Country*
E-Mail Address*
Telephone
Mobile Phone
Postal Address
Status*	(select)
If other please specify

Course Preferences

Please list the major topics covered in your mathematics studies and/or research in 2007.

Indicate which of the following eight courses you wish to attend (first choices). The recommended number is two four week courses. Make sure to tick those "For Credit" boxes on the right that correspond to courses you wish to take for credit. Also select at least two back-up courses in the second list (second choices, in case one your first choices become unavailable or some course gets too full).

First Choices
(select)	For Credit
(select)	For Credit

Second Choices
(select)	For Credit
(select)	For Credit

Academic Sponsor (Students Only)

Starred fields are mandatory for all students. Academic sponsor for honours students can be the honours coordinator and for postgraduate students their supervisor.

Surname*
Other Names*
University/Institution*
Department*
Country*
E-Mail Address*
Telephone
Status*	(select)
If other please specify

Application for Financial Support

Before applying for one of the subsidies available read the information on financial support. Note that students from the Melbourne metropolitan area are not eligible for travel and accommodation subsidies.

Application for financial support: (select)

Accommodation

I require accommodation at Mannix College (Breakfast, lunch and dinner included).

Expected arrival date (select)

Expected departure date (select)

Write comments including dietary requirements in the space below.

T-Shirt

Free T-shirt on arrival (please specify size) Small Medium Large XLarge

Consent

I am aware that ICE-EM may video record parts of the Summer School and take pictures for publicity purposes and/or for educational use. I agree:

to voluntarily participate in the Summer School;
to allow ICE-EM and its authorised representatives to use any recording of myself for promotional and education purposes;
to allow my details to be given to ICE-EM and the Australian Mathematical Sciences Institute.

Submission of Application

Once you have filled in your form you can submit your application by pressing the button below.

Should you experience problems with the automatic registration process, please print out this PDF version of the registration form, fill it in, and FAX it to +613-9905-5020.

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