Workshop Registration

Registration deadline is May 1, 2008

For further information, contact Neil Lutsky at nlutsky@carleton.edu

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

Contact InformationFirst Name:
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Last Name:
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Name of Institution:
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Address:
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City:
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Select a State:

Zip code:
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Phone number:
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Email Address:
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(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.)

What is your Discipline?
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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.)
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Your ActivityProvisional Title for your Activity:
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Travel Information

Please provide as much information about your travel plans as is known at this time. Send additional information to Neil Lutsky (nlutsky@carleton.edu) when it becomes available.

Travel Method:
I will be traveling by car.

I will be traveling by air.

I will be traveling by train.

Incoming Flight InformationAirport
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Date
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Airline
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Flight Number
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Time of Arrival
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Outgoing Flight InformationAirport
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Date
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Airline
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Flight Number
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Time of Departure
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I am interested in sharing ground transportation to the workshop.
I will be renting a car (at my own expense).

Do you have a disability, food allergy, or preference that requires accommodation at the workshop? If so please describe:
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Do you anticipate difficulty walking moderate distances on campus?
Yes

No

Workshop Product Release

In 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.

*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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