2011 Bhopal Conference Registration Survey

2011 Bhopal Conference Registration

1. 2011 Bhopal Conference Registration Page

Join us at the 2011 Bhopal Conference in the San Francisco Bay Area @ Stanford University (Palo Alto), Oct 14-16. Special thanks to the Asha-Stanford Student Group for co-hosting at Stanford! Check them out: http://www.ashanet.org/stanford/

Everyone who wants to attend the conference must fill out the form by October 10, so we can coordinate and accommodate everyone.

Details: housing will be provided for those people coming from out of town on the nights of October 14 & 15. We have agenda items running through the evening of Sunday, October 16. People needing housing on Oct 16 should let us know.

All meals will be vegetarian with a vegan option by request.

Early Bird Registration: Register by September 21 and the fee is $35 for professionals and $20 for students.

Registration Deadline: Everyone must register by October 10! After Sept 21, the fee is $50 for Professionals and $35 for students.

Please pay your registration fee donation by clicking this link (https://www.panna.org/system/give/onlineDonationICJB.php).

The conference costs about $70 per person. Everyone who wants to attend the conference, regardless of financial means, has the right to do so. Please let us know if you will need the fee waived or reduced.

Feel free to contact us with any questions you might have:

Shana – shana.ortman@gmail.com, 415-746-0306
Claire - claire@panna.org, 408-348-2554

Please provide all the information requested and read questions carefully.

Personal Information Full Name
Organization, if any
Address
City, State, Zip
Email
Preferred Phone with Area Code
Emergency Contact Person Name
Emergency Contact Person Phone

If you are flying in, please provide the arrival and departure flight information. The last leg of your arrival flight and first leg of your departure flight is sufficient. We can arrange airport pickups and/or help you with public transportation based on your arrival time. Directions for public transport will be provided on the website. Arrival Airline Name
Arrival Flight Number
Arriving From (Airport Code)
Arrival Date & Time
Departure Airline Name
Departure Flight Number
Departing To (Airport Code)
Departure Date & Time
I haven't booked my flight yet, but I'll let you know as soon as I do

Carpool option. Are you driving or renting a car and willing drive other people?
Would you like to join a car pool if possible?
Have you already arranged a car-pool? If so, who will you be traveling with?
Other car-pool thoughts?

	MM		DD		YYYY		HH		MM	AM/PM
Arrival:	If you are driving to the San Francisco Bay Area, please give us an approximate time for arrival and departure. Please use destination zip code 94115 to estimate travel times. Your host's address will be provided closer to the conference. Arrival: Month	/	Day	/	Year		Hour	:	Minute	AM or PM
Departure:	Departure: Month	/	Day	/	Year		Hour	:	Minute	AM or PM

2011 Bhopal Conference Registration
Exit this survey

1. 2011 Bhopal Conference Registration Page

*
1. Personal Information

*
2. How do you plan to get to the San Francisco Bay Area?

4. Do you need a ride from and/or to the Airport?

5. Carpool option.

6. If you are driving to the San Francisco Bay Area, please give us an approximate time for arrival and departure. Please use destination zip code 94115 to estimate travel times. Your host's address will be provided closer to the conference.

*
7. Housing - do you prefer to stay with:

8. Do you have any special needs that the conference organizers need to be aware of?

*
10. You have completed the registration form - are you ready to party (and to pay the registration fee donation)?!

Do you have any special needs that the conference organizers need to be aware of? Lodging Needs (disabilities, pet allergies, etc)
Food Needs (conference food will be vegitarian; if you are vegan or have any allergies or other needs, you must indicate so here)
Other Needs

2011 Bhopal Conference RegistrationExit this survey

1. 2011 Bhopal Conference Registration Page

*1. Personal Information

*2. How do you plan to get to the San Francisco Bay Area?

4. Do you need a ride from and/or to the Airport?

5. Carpool option.

6. If you are driving to the San Francisco Bay Area, please give us an approximate time for arrival and departure. Please use destination zip code 94115 to estimate travel times. Your host's address will be provided closer to the conference.

*7. Housing - do you prefer to stay with:

8. Do you have any special needs that the conference organizers need to be aware of?

*10. You have completed the registration form - are you ready to party (and to pay the registration fee donation)?!

2011 Bhopal Conference Registration
Exit this survey

*
1. Personal Information

*
2. How do you plan to get to the San Francisco Bay Area?

*
7. Housing - do you prefer to stay with:

*
10. You have completed the registration form - are you ready to party (and to pay the registration fee donation)?!