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Numerical Modeling of Crustal Deformation 2009 Workshop Registration Form

* Indicates required field.

* First Name:

* Last Name:

* Position:

* Institution:

* Primary field of study:

Contact Information

* E-mail Address:

* Phone Number:

* Mailing Address:

* Emergency Contact Name:

* Emergency Contact Phone No.:


Workshop Expectations

* Short statement of your interests and contribution to the workshop:

* Do you want to present a poster (4 X 4 ft)?
Yes No If yes, please give title:

Arrival/Departure

* Expected date/time of arrival (can be changed at later date):
*Expected date/time of departure:

Accommodations

Available accommodations include newly-renovated dorm rooms on the Colorado School of Mines campus and two hotels in downtown Golden (a short walk from campus).

  • Hotel room: you must make your own reservations. See the announcement page for more information.
  • Dorm rooms (private bedrooms with shared living room, bathroom, and shower): Reservations are handled by Ariel Shoresh (please indicate your choice below):

* Do you wish to reserve a dorm room? The dorms are suites with 4 private bedrooms that share a single living room, bathroom and shower. Yes No
If you answered yes, let us know if you are male or female so we can place you with appropriate suite-mates: Male Female
If you know the name of a person you would like for a suite-mate, enter the name below:

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