C e n t r e d e r e c h e r c h e s m a t h é m a t i q u e s
en français
Title: Dr. Mr. Ms.
Status: Graduate student Postdoctoral Fellow Professor Other
Surname: Given name: Institution: Institutional Address (including city, province/state, postal/zip code, country): Mailing Address (if different from the above): Office Telephone: Home Telephone: Fax: E-mail address: WEB address: http:// Citizenship:
Cheque payable to Centre de recherches mathématiques (drawn on Canadian or US bank only)
International money order payable to Centre de recherches mathématiques (drawn on Canadian or US bank only)
Credit card: VISA
Credit card: MasterCard
If you pay by cheque or money order, or if you prefer to send your credit card info. by post, our postal address is:
Centre de recherches mathématiques Université de Montréal Case postale 6128, succursale centre-ville Montréal (Québec) H3C 3J7
Information about credit card:
Name of Cardholder: Number: Expiry Date:
Would you like the CRM to book accommodation for you? Yes No
First choice: Second choice:
Occupancy: Single Double
Date of arrival at hotel: Time of arrival at hotel: Date of departure from hotel:
Please enter any further information or explanatory comments which you would like to include with your registration:
4 mars 1999, webmaster@CRM.UMontreal.CA