Cutting Edge > Enhance Your Teaching > Affective Domain > Mesa, AZ Workshop 09 > Registration Form

Workshop Registration Form

Registration deadline: August 28,2009

Complete the following form and click on SUBMIT to confirm your registration. Be sure to hit the SUBMIT button before leaving this page or your information will be lost. We encourage you to compose your answers to the longer questions in a word processor and to cut and paste the resulting text into this form.
Contact Information























(Please Note: Your email address is what we use to track your application and participation in the workshop. Be sure to use the same email address in all forms relating to your workshop participation. This email will also be our primary means of communication with you.)
Question Set





Demographics





Race (select one or more):





Disability status (select one or more):





































AccommodationsDo you have a disability, food allergy, or preference that requires accommodation at the workshop?

Research ReleaseI have read the Description of the Research Project and Implications for Participation (opens in a new window) or it was read to me. I know the possible risks and benefits. I know that being in this study is voluntary. I choose to be in this study. I know that I can withdraw at any time. I am at least 18 years of age and voluntarily grant permission for the described release and use of notes and comments regarding me in the workshop.



Workshop Product ReleaseIn confirming my registration for this workshop, I agree that any audio recording or images (still or video) made of me during the workshop may be used on the project website, in printed project publications, and in materials developed by the project. I further agree that my contributions to creative works that emerge from workshop activities (e.g., discussions on the listserv, contributions to the web page, summaries of group discussion, etc.) may be used by the workshop series, PIs, and conveners for development of future workshop materials, for scholarly reports, and for promotion of the workshop series. Attribution for original contributions will be made whenever possible.
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