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GEOMETRY AND PHYSICS (CIRM, Luminy, 13-17 October 2003) 
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NAME:

DATE OF BIRTH:

NATIONALITY:

POSITION:

AFFILIATION:

E-MAIL ADDRESS:

POSTAL ADDRESS:

TELEPHONE:

FAX:

Do you wish to present a contribution? (please erase as necessary): YES NO

Title and abstract  of your proposed contribution:

Do you apply for financial support for living expenses?
(please erase as necessary):YES NO

Notes: 

- Financial support is very limited and preference will be 
given to young researchers.

- If you are a member of the European Research Training Networks
European Differential Geometry Endeavour (EDGE) or Geometric Analysis,
you are encouraged to apply to your Network node for financial support.