Participant Information

Name

Preferred Name (for name tag)

Title

Organization

Department

Address

City State Zip Code

Telephone (Format: xxx-yyy-zzzz)

FAX (Format: xxx-yyy-zzzz)

E-mail

URL

Research Interests (Keywords)

Interest in the Program

Please describe briefly your background and reasons for wishing to participate in the program.

Request for Financial Support

I wish to apply for financial support. Support levels will be determined by SAMSI, but will in no case exceed reimbursement for travel and housing expenses supported by proper receipts. For SAMSI's records and reports, applicants for support are requested to E-mail a brief CV or resume (the 2-page format used for NSF proposals is ideal) to multi-workshop200402@samsi.info. New researchers and members of under-represented groups are especially encouraged to apply.

Poster Session

I would like to present a poster.

Title:

The poster boards are tri-fold presentation style.  Dimensions are 3ft (height) x 4ft (width).  The middle section is 2ft wide and each side panel has a width of 1ft.  Please stay within the dimensions of the board. 

NISS Affiliates and NISS/SAMSI University Affiliates Only

Check this box if you are from a NISS Affiliate and plan to request reimbursement from your NISS/SAMSI Reimbursement Account.  Affiliates are expected to pay the registration fee.  Reimbursement request forms will be provided at the workshop registration/check-in desk.

Graduate Students Only

Please check the box below, and in the "special request" block, identify your advisor and dissertation topic.

I am a graduate student.

Special Requests

If you have special requests (such as dietary restrictions), please enter them below. Other questions should be sent by E-mail to multi-workshop200402@samsi.info.

Submission