thwate_e
ABOUT SSL CERTIFICATES  

français

Registration Form

Winter School II: Representation of semisimple and affine Kac-Moody algebras

February 24 - March 7, 2014




*Mandatory fields

Title *

Occupation Status *

Gender *

Surname *
Given name *
Institution *
Institutional Address
Department *
Address *
City *
Province/State *
Postal/Zip Code *
Country *
Mailing Address (if different from above)
Department
Address
City
Province/State
Postal/Zip Code
Country
Telephones and WEB
To include a phone number on the American continent, write the code area followed by the phone number. For international phone numbers, write a + before the country calling code followed by the phone number. If there is an extension, write x and the extension number.
Office Telephone *
Home Telephone
Fax
Cell Phone
Email address *
WEB address http://

Registration fees: $60 per person (non-refundable).

Method of payment:

VISA Credit card

MasterCard Credit Card

If you are paying by cheque or money order, or if you prefer to send your credit card information by mail, our postal address is:

Centre de recherches mathématiques
Université de Montréal
Case postale 6128, succursale Centre-ville
Montréal (Québec) H3C 3J7

Credit card information (must be valid until the beginning of the workshop):

Cardholder Name
Number (16 digits without space)
Expiry Date

 

Further Information

Please enter any further information or explanatory comments which you would like to include with your registration.

If you have completed this form...

 


July 17, 2013, webmestre@CRM.UMontreal.CA