Workshop Registration

Confirmation deadline is February 15

For further information, contact Cathy Manduca

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

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. This gives you access to conveniences like spell checking as well as the opportunity to save and reflect on your work before submitting.

NOTE: If you leave this page before your hit the "submit" button any information you have entered will be lost.
Full Name:

Name of Institution:

First Name for Badge:

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.)

Travel InformationPlease arrive on Sunday March 2 in time for dinner and depart no earlier than 2:00 on Wednesday March 5.
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

Hotel Check here if you have made your hotel reservation at the Hotel 6.
Check here if you will not need a hotel room for the workshop.

Do you have a disability, food allergy, or preference that requires accomodation 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 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.

I also accept responsibility to cover any costs incurred should I withdraw from participation in the workshop after DATE. I understand that arrangements have been made on my behalf that have associated real costs (e.g. logistics, materials), and in many cases, my early confirmation has secured a place that has been denied to other interested colleagues. Exceptions will only be made in cases of extreme personal hardship.
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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