Application for Participation in a Penrose Conference

Please print, complete this form, and mail it to the designated contact person for your conference of choice.

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Penrose
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Title of Penrose Conference _____________________________________________

_________________________________________________________________________


Your name and title______________________________________________________

Organization_____________________________________________________________

Mailing address__________________________________________________________

_________________________________________________________________________


Telephone number (______)________________________________________________

E-mail address___________________________________________________________

Field of interest________________________________________________________

Below, please state briefly what your interest and experience have been 
with regard to the conference topic.