2012 Workshop Registration

Deadline is May 1, 2012.

For further information, contact Jen Wenner

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. Only participants selected through the application process may register. Be sure to hit the SUBMIT button before leaving this page or your information may be lost.

Full Name:

Name of Institution:

First Name for Badge:

Address 1:

Address 2:

City, State, Zip:

Phone Number:

Email Address:

Course information

Over the course of the workshop, we will be working on one or more of your introductory geoscience courses. Please plan to work through your syllabus and or activities in your course during the workshop. In preparation, we ask you to provide us with a recent syllabus for the course (or courses) you want to work on.

Please provide the title(s) of your course(s):

Please upload a file that contains the syllabus for the course you would like to work on at the workshop:
.
Select File Type

Travel Information

In making your travel arrangements, please plan to arrive in Seattle/Tacoma, Thursday, July 26, 2012 by 3 pm and to depart either in the afternoon (after 2 pm) of Saturday, July 28, 2012 or on Sunday, July 29, 2012. Additional information about travel can be found under logistics.

Travel Method:

I will be traveling by car.
I will be traveling by air.
I will be traveling by other mode of transportation

Travel information (Date and time of arrival. Airline and flight #, if flying; or other mode of transportation)

Date, Airline, Flight #, and Time of Departure, if flying.

Do you have a disability, food allergy, or dietary preference (e.g., vegetarian or vegan) that requires accomodation at the workshop?
If so please describe:

Do you anticipate difficulty walking moderate distances on campus?

no
yes

In confirming my registration for this workshop, I agree that any 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 May 1, 2012. 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