*************************************************** GEOMETRY and ARITHMETIC around GALOIS THEORY 8 - 19 JUNE 2009, ISTANBUL GALATASARAY UNIVERSITY http://math.gsu.edu.tr/GAGT/index.html *************************************************** After filling this form please send by e-mail to the address gamsc.school@gmail.com REGISTRATION FORM ----------------------------------------------------------------------------------- Name: Surname: Nationality: E-mail: Postal address: ----------------------------------------------------------------------------------- Institution and Position: Research Interests: Do you want to give a talk? Reference (if you are a student, write name and email of somebody who will give us information about you) ----------------------------------------------------------------------------------- Are you a member of the GTEM network? : ----------------------------------------------------------------------------------- FINANCIAL SUPPORT. Expenses of GTEM members are expected to be covered by their Nodes. There is a TUBITAK support available for local participants. Please answer the following questions if you are not covered by TUBITAK or GTEM, and if you are eligible for ICTP or IMU support (see the list of eligible countries at http://oea.ictp.it/supported/) Do you request financial support for travel? : Estimated cost: Do you request financial support for accomodation?: ----------------------------------------------------------------------------------- Your comments: -----------------------------------------------------------------------------------