ACM Pedagogic Resources > ACM/FaCE > Projects > Innovation and Entrepreneurship in the Liberal Arts Curriculum > Registration

Register for the Workshop

Confirmation deadline is August 12, 2011

There are still a few spots available. Registration will close when all spots are filled.

Note that funding is limited, so early registration is encouraged for those who wish to take advantage of funding for accommodation and meals. For further information, contact Adam Galambos.
Please download the following medical and emergency information form, complete it, and bring it with you to the workshop in a sealed envelope. Medical Emergency Information Form

Complete the following form and click on SUBMIT to confirm your registration.

You must complete this form in one sitting; you cannot save a portion and return to fill out the rest later. We'd 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.

Be sure to click SUBMIT when you are done. Remember that you will not be able to alter your registration information via this form once you have submitted it, so please be sure you have completed all fields before submitting.

Participant InformationFirst Name:

Last Name:

Name of Institution:

Name for Badge:

Email Address:

Confirm Email Address:

(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.)

Cell Phone Number (This information is only used to contact you if there are issues that arise during your transit to or from the workshop.)

Workshop QuestionsWhy are you interested in participating in this workshop? Check all that apply.
Teaching quandary. You hope to figure out a solution to a specific issue you came across in a course.
Research interest. This workshop aligns with your own academic interests.
Pedagogical interest. You have always wanted to teach students this content, set of skills or in this manner.
Colleague suggestion. A colleague recommended the workshop to you.
Community interest. You want to take part in an activity with like-minded colleagues outside of your institution (as well as learn something).
Career development. You want to prepare yourself for the next stage of your career.
Other:
If other, please specify:

Do you anticipate teaching a course related to innovation or entrepreneurship in the next two years? If yes, please include some details.

Are you currently pursuing or interested in pursuing a research project related to innovation and entrepreneurship? If yes, please include some details.

Travel Information

We expect most participants to cover most of their travel expenses, but the ACM FaCE grant sponsoring this symposium does include a small budget for travel. If you would like to apply for some travel funding, please indicate the nature and amount of funding.

No
Yes

If Yes, please indicate the amount you are requesting and what expenses you would like to cover.

Travel Method:

I will be traveling by car.
I will be traveling by air.
I will be traveling by train.

Incoming Flight InformationAirport

Date

Airline

Flight Number

Time of Arrival

Outgoing Flight InformationAirport

Date

Airline

Flight Number

Time of Departure

I am interested in sharing ground transportation to the workshop.
I will be renting a car (at my own expense).

Participant InformationPlease check the appropriate boxes so that we have an accurate count for hotel and meal reservations. Accommodations and meals are included in the ACM FaCE grant sponsoring the symposium.
I need hotel accommodation for Friday night.
I need hotel accommodation for Saturday night.
I will attend dinner on Friday.
I will attend breakfast on Saturday.
I will attend lunch on Saturday.
I will attend dinner on Saturday.
I will attend breakfast on Sunday.
I plan to attend the optional campus tour Friday late afternoon.

AccommodationsDo you have a disability, food allergy, or preference that requires accommodation at the workshop? If so, please describe:

Do you anticipate difficulty walking moderate distances on campus?

Yes
No

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 email list, contributions to the web page, summaries of group discussions, 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.

Name Email *Please type the two distorted words into the box below. Separate them with a space. This helps us prevent spam. For more details or help click the question mark.

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