CONFERENCE IN HONOR OF THE 65th BIRTHDAY OF MIKHAIL SHUBIN
          	    		 SPECTRAL THEORY AND GEOMETRIC ANALYSIS
					July 29 - August 2, 2009
				Northeastern University, Boston 

                               		Registration form

Please use plain text only (e.g. no TeX, postscript, pdf etc., please) when 
filling out this form and email it to shubinconference@gmail.com. 
Do NOT send this form to us as a MS Word file (a .doc file). Please send it as a text (ASCII) 
file.

Last name, first name:


Your capacity/title at home institution:


Your address (i.e. your department, university, street, city, state, 
zip code, country):


Email address:


Current advisor (if applicable):


Expected arrival and departure dates:

Would you like to present a poster: (yes/no)
If yes write here your title and abstract:

Will you apply for a visa (yes/no):


Do you need a letter of invitation (yes/no):

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FILL OUT THE NEXT SECTION ONLY IF YOU ARE REQUESTING SUPPORT:

Amount requested for travel (list all items, e.g. air fare, accommodations 
(shared room only, indicate number of nights),...):


Do you expect funding from other sources? List all sources and amounts:


Will you attend the symposium if only partial funding is provided (yes/no):


Are you a US citizen or a US resident (green card holder) (yes/no):


Please explain your interest in the symposium (do not exceed 10 lines, please):


It would be helpful if you could provide a short vita and list of publications 
(do not exceed 20 lines, please):


If you are a graduate student or postdoc it would be helpful if you could
have one or two individuals send a letter of reference to
shubinconference@gmail.com. Indicate which individuals you have asked to
send letters (name and email address, please):