DIMACS Workshop Registration Form

DIMACS/CCICADA Workshop on S&T Innovations in Hurricane Sandy Research

June 5, 2013

Please fill out the following form to register. Required fields are marked with *.

When finished and you have checked the correctness of information, press the "send" button at the bottom of the form.

Attendance is limited to available space; please register early.


       




Your First Name: *Your Last Name:
*Your Position:
Your Postal Address: (This information will be used for nametags & mailing lists) Name of organization: (University or Company Name)
*Organization Type: Department: Street Address: City, State, Zip Code: Country:
Phone: Fax: *E-Mail: Web page URL:
Comments: (i.e. dietary restrictions)





The workshop organizers have granted me a registration fee waiver.
The workshop organizers have not granted me a registration fee waiver.
This status will be verified prior to the workshop.

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