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MATHEMATICS INSTITUTE - UNIVERSITY OF WARWICK
COMPUTATION AND CHAOS:
modern methods in nonlinear dynamics
POSTPONED
to later in the year

A
PPLICATION FORM
This form (3 pages) should be printed, filled-in and posted to the address at the bottom. An electronic mailing version is not available at present.
PERSONAL INFORMATION (block capitals please)
Name: (please underline Family name)
Title:
Organisation:
Organisation Address:
 
 
 
Post/Zip Code:
Country:
Telephone No: (include area/country code)
Fax No: (include area/country code)
E-Mail:
I wish to attend the above course. Accordingly (please indicate with a tick):
I enclose a copy of my full Curriculum Vitae        
and
I enclose a covering letter (to be completed below) indicating how I
would benefit by attending this course at this stage in my career
 
We will write regarding your place on the course shortly after we received your application.
FEES
Regarding the course fee and related expenses (please indicate with a tick):
I enclose a cheque for the £2,000 course fee (payable to 'University of Warwick')  
or
Please invoice my organisation for the £2,000 course fee  
or
I am unable to send my course fee at this time please see overleaf for my details  

DECLARATION
I certify that the statements made by me on this form and on my Curriculum Vitae are correct.
I have carefully read the information for this course to which I am applying.
I understand that, if admitted to the course, should my funds at any time during the course prove to be inadequate, the Mathematics Institute or the University of Warwick will not be able to provide assistance with a grant or remission of fees.
I understand that the course will be taught in English and that I will need to be able to communicate effectively in the language in order to benefit fully from the programme.
 
We would be interested to hear of areas of mathematics in which you may be interested in attending a course:
Future courses of particular interest to me are (please specify):
 
 
I heard about this course from (please give as much detail as you can):
Receipt of information by mail:
Information through colleague(s):
Other (please specify)
 
 

COMPUTING EXPERIENCE

PERSONAL STATEMENT (including how you feel you will benefit from this course; and relevant information not included on your CV; reasons for not including the course fee. Can be continued on separate sheet if necessary.)

Signature of Applicant:
Date:

Please complete this form and send to:

MIR@W Secretary
Mathematics Institute
University of Warwick
Coventry CV4 7AL, UK