Confirm Your Registration

Confirmation deadline is April 11, 2007

For further information, contact Cathy Manduca.

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.

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. Also, please note that after you submit this form, you will no longer be able to edit your information via this form so be sure to complete all fields before submitting.

Once you have submitted the information requested on this form, you will be directed to the forms where you will upload the teacher preparation course and activity information that were described in the letter notifying you of your acceptance to the workshop. If you cannot complete all these forms at once, there are also links to them in the navigation menu on the left side of your screen. Notice, however, that your registration is NOT complete until you have uploaded all of your course and activity information.

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.)
.

Please check here if you are able to bring a laptop with you to the workshop.

Travel Information

The workshop will begin at 5 p.m. on Thursday, May 10th with a reception and welcoming remarks. Please make your plans so that you will be able to attend this opening session. We will conclude after dinner on Saturday, May 12th. It is essential that you attend the full workshop program.

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 will be renting a car (at my own expense).

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 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.

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.

*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.

« Previous Page Next Page »