2024 Mathematical Problems in Industry (MPI) Workshop Application

Please complete this form to register for the 2024 MPI Workshop, held June 25-29 at University of Vermont, Burlington, Vermont, USA. If you have questions or need assistance completing this form, please contact programs@siam.org. For more information about MPI please visit go.siam.org/mpi.

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* 1. Name
Please enter your name EXACTLY as you wish it to appear on your name badge. 

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* 2. Email address

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* 3. Physical Address

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* 4. Contact phone number
000-000-0000

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* 5. Affiliation

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* 6. Sector

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* 7. Department

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* 8. Current education level

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* 9. Position/Job title
Ex. scientist, assistant/associate/full professor, postdoc, grad student, etc.

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* 10. If you're traveling from out of town, would you be interested in our hotel block?
Limited support for travel and accommodation is available for problem-solvers; see your acceptance letter for details. If you plan to secure your own accommodations, please select "no."

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* 11. Expected arrival/departure dates

Date
Time
Date
Time

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* 12. Workshop Role

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* 13. Would you like to be considered for travel (flight and hotel) support?

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* 14. Will you attend the workshop dinner?

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* 15. Dietary restrictions (select all that apply)

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* 16. Gender

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* 17. Ethnicity

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* 18. Race

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* 19. If you have participated in previous Mathematical Problems in Industry Workshops or other comparable workshops, please list them here. Ex: MPI 2023

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* 20. Acceptances may be based on how applicable an individual’s area of expertise is to the industrial problems being presented at MPI. Please list your areas of expertise in the box below.

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