Travel Plans Form

Confirm Your Travel Information

Confirmation deadline is October 16

For further information, contact the Krista Herbstrith in the SERC office at kherbstr@carleton.edu.

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:

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.)

Emergency Contact (if you would like to provide a name and phone number for an emergency contact, please enter it below)

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. If you have a SERC account, please use that e-mail address)

Travel InformationTravel Method:

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

If arriving by car or train, please enter your arrival date (please use format month/date/year ie: 2/23/13):

If departing by car or train, please enter your departure date (please use format 2/23/13):

Incoming Flight InformationAirport

Date (please use format 2/23/15)

Airline

Flight Number

Time of Arrival (please use format 1:23pm)

Outgoing Flight InformationAirport

Date (please use format 2/23/15)

Airline

Flight Number

Time of Departure (please use format 1:23pm)

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

Do you anticipate difficulty walking moderate distances on campus?

Yes
No

Name Email

« Previous Page