Workshop Registration

GeoPRISMS 2013 Face-to-Face Workshop

Please confirm your registration via this form as soon as possible, but no later than July 12.

Complete this form and click on the SUBMIT button at the bottom of the page to send us your registration information. Please note that you cannot return to the form later, it must be filled out and submitted in one sitting.

This registration form is for use only by applicants accepted to the workshop. If you have not been notified of your acceptance, do not complete this form. Please contact Kristin O'Connell with any questions. (koconnell@carleton.edu)

Contact InformationFirst Name:

Last Name:

Name for Badge:

Your institution:

Your department:

Select your mini-lesson team:

Subduction Factory (SubFac)
Seismogenic Zone Experiment (SEIZE)
Rupturing Continental Lithosphere (RCL)
Source to Sink Sediment Cycling (S2S)

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 associated with your SERC account.)

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.)

If there is anyone you would like us to contact in the unlikely event of an emergency during the workshop, please enter their name and contact information here:

Preliminary Travel InformationPlease let us know when you plan to arrive and depart.

Hotel InformationOur grant will cover the cost of lodging on Wednesday 9/18 and Thursday 9/19 (and Friday, 9/20 if necessary) for double occupancy rooms.
If you prefer, you may request a private room. You will be responsible for paying for this option ($45 per night).

Double occupancy, no roommate preference.
Double occupancy, roommate preference (indicate below)
Single occupancy, I will pay $45 per night for this option when I submit travel plans . (Single occupancy rooms are limited in number and cannot be confirmed until we have received payment)

If you prefer to be paired with a specific roommate, please indicate your preference here.

AccommodationDo 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?

Yes
No

Name Email