Registration Form

Mid Atlantic Numerical Analysis Day

Friday, 4 November 2011
Temple University

First and middle name(s):

Last name(s):


(as it should appear on your badge and abstract)

Email address:

Are you a member of at least one of the following races/ethnicities: Black or African American, Native American, Hispanic or Latino?
Yes   No   Do not wish to provide
(we are required to ask this for statistical purposes)

Year of (expected) PhD:

Name of PhD thesis advisor:

Email of PhD thesis advisor:

If you plan to attend without giving a talk or presenting a poster, then please proceed directly to submit.
If you would like to give a talk or present a poster, please continue to fill out this form. The deadline for the submission of abstracts is September 15, 2011.

Type of contribution:

Attending only, without talk or poster

Title of talk/poster:


If your choice of contribution type (talk/poster) is not possible, would you be willing to give a poster/talk instead?
Yes No

You will receive an answer of acceptance by the end of September.