Probability and Discrete Mathematics in Mathematical Biology
(14 Mar – 10 Jun 2011)

Please submit the completed application form together with the relevant documents to email: or fax: +65 6873 8292.

1.  APPLICATION REQUIREMENTS

(a) A copy of your Curriculum Vitae
(b) Two letters of recommendation to be mailed/faxed/emailed to us directly.
(c) A list of publications (if applicable)

2.  PERSONAL PARTICULARS

Title and Full Name as in Passport/Identity Card (underline Surname/Family Name): / Designation: (Prof/PhD student etc.)
Prof / Dr / Mr / Mrs / Ms**
Institution Name & Address: / Contact Details
Office: / Mobile:
Home: / Fax:
E-mail:
Postal Address: (if different from above address): / Nationality:
Passport No.: / Date of Issue:
Place of Issue: / Date of Expiry:
Date of Birth: / Country of Birth: / Gender*: Male Female

3.  Please complete this section, if you are applying for Financial Support.

a) Activities you would like to attend
Topics on Discrete Mathematics and Probability in Population Biology and Genetics
Tutorial: 21 – 25 Mar 2011
Workshop: 28 Mar – 1 Apr 2011
Topics on Discrete Mathematics and Probability in Networks and Population Biology
Tutorial: 2 – 6 May 2011
Workshop: 9 – 13 May 2011
** The remaining time will be devoted to collaborative research, informal seminars on topics of current interest, and other related activities.
b) Please indicate the type(s) of local financial support required from the Institute* :
Accommodation Allowance
Others (please specify) :
c) Have you applied or been granted financial support from other sources for your visit* :
Yes No
If yes, please provide details:
d) If your application for Financial Support is unsuccessful, would you be interested to attend the program*:
Yes No

4.  ITINERARY

Date of Arrival (confirmed/tentative): / Date of Departure (confirmed / tentative):
Please note that successful applicant for financial support on accommodation will be placed at campus-accommodation as allocated by the Institute.

Institute for Mathematical Sciences (IMS) :: National University of Singapore :: 3 Prince George's Park, Singapore 118402 :: 65-6873 8292 (Fax) :: (E) :: www2.ims.nus.edu.sg (W)
Page 2 of 2