APPLICATION FORM CTEQ Summer School on QCD Analysis and Phenomenology at Puebla, Mexico 19 - 27 May 2005 Name: (Last, First) Home Institution: Current Mailing Address: Daytime Phone Nr: Fax Nr: Preferred E-mail Address: Month/Year Ph.D. obtained or expected: Have you attended a previous CTEQ Summer School? NO WHICH YEAR? Gender: male_____ female_____ Special dietary requirements (vegetarian...)__________________________ Your application, curriculum vitae with publication list, and one letter of reference must be received by *** 15 April 2005 ***. Please submit your application package via E-mail to: TGROZIS@FNAL.GOV or via hard copy to: Ms. Terry L. Grozis CTEQ School Fermilab - M.S. 205 P.O. Box 500 Batavia, IL 60510 Fax (630) 840-2194