Registration Form |
Please fill in all relevant information. *=required fields |
* First Name: |
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* Last Name: |
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* Affiliation: |
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* Status: |
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* Year Ph.D. was obtained: |
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* Address: |
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* City: |
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* State: |
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* Zip: |
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* Phone : |
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* Email Address : |
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For those who qualify (students, post docs, junior faculty) we will pay for shared accomodations
(double room) for the nights Thursday April 23, Friday April 24 and Saturday April 25
at the Highway House or the Plaza Inn. You are responsible for your hotel reservations. |
Which nights will you attend?
Thursday
Friday
Saturday
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Are you interested in a contributed talk:
yes
no |
I will be traveling by car:
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I will be flying into Albuquerque:
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Do you need travel support:
yes
no |
The conference is sponsored by NSF, the following information witll be
useful for reporting purposes (no individual data will reported, just statistics): |
The
following definitions are used by the federal government.
- White: (Not of Hispanic Origin): A person having origins
in any of the original peoples of Europe, North Africa, or the
Middle East.
- African-American: (Black/Not of Hispanic Origin): A person
having origins in any of the Black racial groups of Africa.
- Hispanic: A person of Mexican, Puerto Rican, Cuban, Central
or South American or other Spanish culture or origin, regardless
of race.
- Asian or Pacific Islander: A person having origins in
any of the original people of the Far East, Southeast Asia,
the Indian Subcontinent, or the Pacific Islands. The area includes,
for example, China, Japan, Korea, the Philippine Islands, and
Samoa. The Indian Subcontinent takes in the countries of India,
Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan.
- American Indian or Alaskan Native: A person having origins
in any of the original peoples of North American and who maintains
cultural identification through tribal affiliation or community
recognition.
- Disabled Veteran: A person entitled to disability compensation
under laws administered by the Veterans Administration for disability
rated at 30% or more, or a person whose discharge or release
from active duty was for a disability incurred or aggravated
in the line of duty.
- Vietnam Era Veteran: A person who served on duty for
a period of more than 180 days, any part of which occurred between
August 5, 1964 and May 7, 1975.
- Individual with Disabilities: The Rehabilitation Act
of 1973, as amended, defines a "handicapped individual"
and the American with Disabilities Act defines a "qualified
individual with disabilities," for the purpose of the program,
as any person who (1) has a physical or mental impairment which
substantially limits one or more of such person's major life
activities: (2) has a record of such impairments: or (3) is
regarded as having such impairment.
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American Indian or Alaskan native
Hispanic
African-American (Non-Hispanic)
White (Non-Hispanic)
Asian or Pacific Islander
U.S. Citizen?
yes
no
Disabled?
yes
no
30% Disabled Veteran?
yes
no
Vietnam Era Veteran?
yes
no
Gender
male
female
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