MPE 2013+ Workshop Registration Form

Workshop on Sustainable Human Environments

April 23 - 25, 2014


Please register by filling out the following blanks. When finished and you have checked the correctness of information, press the "Submit" button at the bottom of the form.
Note: If you are an early career researcher and wish to apply for travel support to the workshop, plase visit the application for early career researchers website at http://dimacs.rutgers.edu/Workshops/HumanEnvironments/applicant.html . Early Career Researchers are defined as faculty or researchers who have earned their doctorate within the previous three years, postdocs, graduate students, and upper-level undergraduates with research experience.

Attendance is limited to available space; please register early.

Personal Information 


  Dates you plan to Attend: 


           Your First Name: 
          Your Middle Name: 
            Your last Name: 


             Your Position:


* Eligible to apply for travel fellowship to attend workshop.
** Early Career Researchers are defined as faculty or researchers who have earned their doctorate within the previous three years, postdocs, graduate students, and upper-level undergraduates with research experience.
Contact Information: (This information will be used for name tags, mailing lists, and determining registration fee amounts) 

 
     Name of organization: 
                            (University or Company Name)


             Attendee Type:  
                Department: 
            Street Address: 
     City, State, Zip Code: 
                   Country:
* Early Career Participant is defined as a faculty member whose doctorate was completed within the last three years, postdoc, graduate student or undergraduate student. Early Career registrants are encouraged to apply for a travel scholarship at http://dimacs.rutgers.edu/Workshops/HumanEnvironments/applicant.html .

Note: Participants will be instructed on how to pay registration fees, if any, when an invitation is sent.

                    E-Mail: 
                     Phone:  
                       Fax: 
              Web page URL:

Contact Bidisha Nag (bidishan@dimacs.rutgers.edu) if you have questions about hotel accommodations.

Special Needs:
If you have any special needs with which you may need help, please indicate them here.


Activities

Poster Session:
"A poster session is planned for the workshop covering topics related to sustainable human environments. Do you plan to contribute a poster?
No Yes
If you would like to contribute a poster, please provide a title/abstract in the space provided or send a title/abstract to mpe2013plus (at) dimacs.rutgers.edu no later than February 1, 2014
Poster title/abstract:


Dietary Needs:
Please indicate any dietary needs you have here.


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