Confirm Your Registration

Confirmation deadline is ENTER DATE

For further information, contact INSERT COVENER EMAIL HERE

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

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

First Name:
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Last Name:
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Name of Institution:
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Name for Badge:
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Email Address:
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Confirm Email Address:
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(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.)
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In general, what are the features that you look for in a strong teaching activity?
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Question 2
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Question 3
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Question 4
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Travel Information

INSERT PARAGRAPH ABOUT TRAVEL LOGISTICS HERE.

Travel Method:
I will be traveling by car.
I will be traveling by air.
I will be traveling by train.
Incoming Flight InformationAirport
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Date
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Airline
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Flight Number
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Time of Arrival
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Outgoing Flight InformationAirport
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Date
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Airline
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Flight Number
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Time of Departure
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I am interested in sharing ground transportation to the workshop.
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:
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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 email list, 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.