International Workshop on Complex Systems and Networks 2009

University of Bristol, 20th - 22nd July 2009

Registration Form

Deadline for submission: 6th April 2009 EXTENDED until 15th May 2009

If you have any questions about completing this form, please e-mail bcanm-events@bristol.ac.uk.

1. Personal and contact details

Title

Forename

Surname

Department
(e.g. Department of Mathematics)

Institution
(eg. University of Bristol)

Postal Address

e-mail address

WWW home page
(if appropriate)

Telephone number
(e.g. +44 (0)117 928 9000)

Fax number
(e.g. +44 (0)117 925 1154)

2. Academic information

Type of registration

Academic staff	UK EU Non-EU
PhD student, studying in	UK EU Non-EU
Other	Please state employer:

PhD details
(for current PhD students only)

Year of PhD study
Funding body
Advisor(s)
Dissertation title

PhD students must send a reference from their advisor or Head of Department agreeing to their attendance, and stating why this meeting will be of benefit to them and what they can contribute to it. Please arrange for this to be sent by e-mail to bcanm-events@bristol.ac.uk - to arrive by the closing date, 6th April 2009.
Please indicate if such a reference has been sought Yes No

Student Support

Limited funds are available to cover accommodation, including all meals and travel to the conference (UK PhD students are expected to claim travel expenses from their home institution). Please indicate whether you would be interested in applying for these funds
Yes No

PhD details
(for those who already hold a PhD)

Year awarded
Institution

If you would like to be considered for contributing a talk/poster, please provide details (n.b. slots for both talks and posters are limited)

Title :
Abstract (max. 200 words) :

3. Other information

Attendance

Please indicate your attendance option choice:

1. Student (£100 for 3 days)
2. Non-student (£150 for 3 days)

Names of any accompanying persons

Any other details
(Please notify us of any special requirements: disabilities, special accommodation needs, other dietary requirements, etc.)

International Workshop on Complex Systems and Networks 2009

Registration Form

Deadline for submission: 6th April 2009 EXTENDED until 15th May 2009

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