Registration Form

Categorical Methods in Geometry and Gauge Theory
Chern Institute, Nankai University, Tianjin, China
29 August - 3 September 2010

Please complete and email to
e-mail: cmggt2010@gmail.com AND baicm@nankai.edu.cn 

1. Full Name:              (last)              (first)             (middle)     
2. Date and Place of Birth:            (day/month/year)              (Place)
3. Gender:                     Nationality:                                 
4. Affiliation:                                                             
5. Title:                                                                                                                                     
6. Passport Number:                           Valid until                       
7. Permanent Address:                                                      
                                                                        
Mailing Address (if different from above)                                          
                                                                       
8. Telephone number (including international code):                             
Fax number (including international code):                                    
9. E-mail address: 
                                                       
10. Intended duration of visit
From                           to                             in China
From                          to                             in Nankai
11. Accompanying persons
Name             Relationship          Passport number        Valid until
                                                                         
                                                                      
12. I would like to present a contribution to scientific program (YES/NO)
If YES, tentative title