DIMACS Workshop Registration Form

                    DIMACS Workshop Registration Form
               Workshop on Computational Biology at part of
		      the 50th Anniversary of ENIAC
			     May 17-19, 1996
     
Name:  ..................................

Title:  .................................

Affiliation:  ...........................      

Address:  ...............................

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Country: ................................

Phone:  .................................

Fax:  ...................................

Email:  .................................

Talk title/topic:  .....................................................

Will you want to give a software demo?  Yes ....  No ....  Maybe  ......

Other special needs: ...............................................

To help us improve publicity and to gather information requested by
sponsors, please answer the following:

Is your position primarily:

Student: __   Faculty: __  Researcher: __  

Is your home institution:

University: __  Corporate Lab: __  Government Lab: __  

Other (Please describe):. ..............................................

How did you hear about this workshop: ..................................

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