Blackwell-Tapia Conference, November 14-15, 2008

19 T.W. Alexander Drive
P.O.Box 14006
Research Triangle Park, NC 27709-4006
Tel: 919.685.9350
Fax: 919.685.9360
info@samsi.info

SAMSI Special Workshop

Blackwell-Tapia Conference

November 14-15, 2008

Workshop Application/Registration

To apply to attend the workshop or for travel support, or to register if you are an invited participant, please fill out the form below, and then click the SUBMIT APPLICATION/REGISTRATION button. Items in red are required. Following submission, a confirmation of your application or registration will be displayed. (Print a copy for your records.) Applicants will be notified as soon as possible if their application is approved, and should not make travel arrangements until notification is received.

Applications/registrations will be considered until the workshop capacity is reached. No applications will be accepted after October 31, 2008.

SAMSI Travel Policy

Registration Fee: There is no charge to attend this conference.

Participant Information

First Name Family Name

Title

Organization

Department

Discipline

Address

City

State (Use NA if not US)

Province

Zip (or Postal) Code

Country Required if not US

Telephone

FAX

E-mail

URL

Interest in the Program

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

Status

Student Faculty/Professional

Poster Presentations

Check here if you wish to present a poster at the poster session, and if so provide the title.

Poster Title

Poster Session Attendance

I will attend the poster session.

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 B-T2008@samsi.info. New researchers and members of under-represented groups are especially encouraged to apply.

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.

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.

Invited Participants Only

Check here if you are an invited participant.

If you are an invited speaker, please provide the title and abstract of your presentation.
If you are invited but you are not presenting a talk, put N/A in the Title section and the Abstract section below. This is to ensure your registration will be submitted properly.

Title

Abstract

Special Requests

If you have special requests (such as dietary restrictions or a guest for the poster session), please enter them below. Other questions should be sent by E-mail to B-T2008@samsi.info.

Submission

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