Financial Support Application
Finite Simple Groups, Geometries,  and Related Topics
Conference in Honor of Ernest Shult
March 22-24, 2001
Kansas State University, Manhattan, Kansas
(http://www.math.ksu.edu/conf2001)

Last Name: ____________________________________________First Name: ___________________________________

Social Security Numbers  _____-____-___________     Country of Legal Residence _________________

Affiliation: ___________________________________________________________Titlle/Grad. St___________________

Mailing Address: ____________________________________________________________________________________

City/State//Zip Code_______________________________________________Country___________________________

E-mail Address: _________________________________________________________________________

Telephone: ______________________________________ Fax: _______________________________

Estimated cost for attanding the conference: (All funds are in US Dollars)

Hotel Cost: _____ days x $_____(per/day) Total $_______

Travel  Cost:   Airfare $______   Other ___________    $_______     Total Travel Cost  $_______


Do you have any other  source of support to attend the conference?      Yes____     No____

If  yes, indicate:   Sources (or agencies)__________________________________     Amount  $_________________

The amount you are applying for support from the conference:  $_________


I swear that the above information is accurate based on my best knowledge.

______________________________________                            _______/_____/______________
Signature                                                                                                    Date  (dd/mm/yyyy)


Send the form to: Lindsay Thompson, Dept of Mathematics, Cardwell Hall 138, Kansas State University, Manhattan, KS 66506, USA,   Fax: 785-532-0546.