Full Name:

Social Security No:

Status: (Circle one) Graduate Student Faculty Other

The following information is needed for reimbursement of conference expenses.

In the allocation of funding, we are giving priority to suitable graduate students and

presenters of 20 minute talks. Most likely funding will only be available for local

expenses.

Accommodation $

Air Travel (Round trip economy class) $

Other Transportation $ ($ .28 per mile for auto travel)

Number of complete days at conference:

Food (including banquet) $

Are you getting funding from other sources? Yes No

If so, how much and for what expenses? $