REGISTRATION: A Celebration of Geometry, Analysis and Physics. Conference honouring Niky Kamran on his 60th birthday

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REGISTRATION

A Celebration of Geometry, Analysis and Physics. Conference honouring Niky Kamran on his 60th birthday

June 10 - 14, 2019

* MANDATORY FIELDS

IDENTIFICATION*

TITLE*
NAME*
Given Name

Family Name
OCCUPATION*
Gender* (for statistical purposes)
Language of correspondence*
AFFILIATION*

Affiliation

Department

Address of Affiliation

City

Postal Code / Zip Code

Please choose a country:

Please choose a state, province or area:
CORRESPONDENCE ADDRESS

Please fill out the following if different from the affiliation.
Correspondence address
Address

City

Postal Code / Zip Code

Please choose a country:

Please choose a state, province or area:
TELEPHONE (with dialing code), EMAIL ADDRESS AND WEB SITE

Email address*
Secondary email address
Office phone*
Home phone
Fax
Cellular Phone
Web Address
Twitter

REGISTRATION FEES*

Registration fees are non-refundable.

Registration Fees $CAN
BANQUET

The cost of the banquet is 75 CAN$ per person.
Number of banquet tickets required
$CAN Total banquet

Total banquet
Special menu. If yes, which one?
TOTAL FEES

Total fees $CAN
PAYMENT *

Only payment by VISA or Master Card is accepted. Integrated debit credit card refused.

Credit card information must be valid until the beginning of the workshop.

The following amount will be debited from your credit card.

Payment Card
Name of the credit card holder
Credit card number
Expiry date on credit card MM/YYYY
Your three numbers or CVV (Card Verification Value):
MISCELLANEOUS INFORMATION

Please write any other information or comment.