*************************************************************************

   Please complete and mail this form to workshop@star.sr.bham.ac.uk
              by the registration deadline of 15th January 2015

*************************************************************************

              14th Birmingham-Nottingham Extragalactic Workshop
                   Cosmic Overdensities Through Cosmic Time
                             February 17-18, 2015


Name:-

Institute:-

(Delete below as applicable)

(a) I would like to attend the Workshop but not make a presentation.

(b) I would like to present a poster entitled:-

(c) I would like to give a talk entitled:-

    Brief description of talk:-

    Preferred duration [15 min/30 min]:-

N.B. Talks should be closely related to the theme of the workshop.


*************************************************************************